Methods and devices for controlling motorized surgical devices

ABSTRACT

Methods and devices for controlling motorized surgical devices are provided. In general, the methods and devices can allow a surgical device to grasp and cut tissue. In some embodiments, the device can include at least one sensor and a motor, and an output of the motor can be configured to be adjusted based at least in part on an output from the at least one sensor. The output of the motor can be configured to provide power for translation of a cutting element along an end effector of the device. Adjusting the motor&#39;s output can cause the cutting element to translate through the end effector at different speeds, thereby allowing the cutting element to cut through tissue being grasped by the end effector at different speeds.

FIELD

The present invention relates to methods and devices for controllingmotorized surgical devices.

BACKGROUND

Various surgical devices are used for compressing and cutting differenttypes of tissue. In general, these devices have jaws configured to grasptissue and a cutting mechanism configured to be advanced through thetissue to sever it. These devices can also apply energy to the tissuedisposed between the jaws to promote hemostasis.

A common concern when using any of these devices is achieving hemostasisso that bleeding of the target tissue is limited. By increasing theamount of pressure applied to the target tissue, the flow of blood canbe limited, decreasing the time necessary to achieve hemostasis.However, applying too much pressure too quickly to the tissue before thetissue is ready can result in trauma to the tissue, which can result infracturing of vessels near the cut-line, potentially resulting in anelevated level of necrosis, a slower rate of healing, and/or a greaterrecovery period. An optimal amount of force depends on various factors,including the type of tissue, its thickness, and disease state.

Accordingly, there remains a need for improved methods and devices forcontrolling motorized surgical devices.

SUMMARY

A surgical device is provided that in one embodiment includes an endeffector including first and second jaws configured to engage tissuebetween facing engagement surfaces thereof. The surgical device can alsoinclude a sensor configured to sense an impedance of the tissue engagedbetween the facing engagement surfaces, a cutting element configured tocut the tissue engaged between the facing engagement surfaces, a motorconfigured to provide an output that causes the cutting element totranslate through the end effector at a speed, and a controllerconfigured to change an output of the motor based at least in part onthe sensed tissue impedance, thereby controlling the speed of thecutting element translating through the end effector.

The surgical device can vary in any number of ways. For example, thecontroller can be configured to change the output of the motor in realtime with the cutting element translating through the end effector. Foranother example, the controller can be configured to prevent a velocityof the motor from exceeding a predetermined maximum threshold velocityduring the translation of the cutting element through the end effectorbased at least in part on at least one of a current of the motor, avoltage of the motor and on revolutions per minute (RPM) of the motor,the current, the voltage, and the RPM being proportional to a load ofthe cutting element. For still another example, the controller can beconfigured to repeatedly and sequentially increase and decrease avelocity of the motor in response to the velocity of the motor reachinga predetermined threshold velocity. The repeated sequential increasingand the decreasing of the velocity can continue until the velocity ofthe motor falls below the predetermined threshold velocity. For yetanother example, the controller can be configured to cause a feedbacksignal to be provided to a user. The feedback signal can be indicativeof the speed of the cutting element. The feedback signal can include atleast one of a light, a sound, a vibration, and a visual textualdisplay. For another example, the surgical device can include a handleconfigured to be actuated by a user so as to move the first and secondjaws from an open position to a closed position. The controller can beconfigured to prevent the translation of the cutting element through theend effector until the first and second jaws are in the closed position.For yet another example, the sensor can be disposed within a housing ofthe surgical device that is configured to be handheld by a user. Foranother example, the sensor can be remotely located from a housing ofthe surgical device that is configured to be handheld by a user, and thesensor can be configured to be in electronic communication with thecontroller from the remote location. For still another example, thecontroller can also be configured to change the output of the motorbased at least in part on a linear force of the cutting element movingthrough the tissue. The controller can be configured to calculate thelinear force in real time with the cutting element moving through thetissue based on one or more of the current of the motor, the voltage ofthe motor, the RPM of the motor, and the drivetrain of the motor. Foryet another example, when the cutting element is cutting the tissue, thecontroller can be configured to control the output of the motor suchthat the output of the motor cannot exceed 80% of a total outputcapability of the motor, and after the cutting element has cut thetissue, the controller can be configured to control the output of themotor such that the output of the motor is allowed to exceed 80% of thetotal output capability of the motor. For another example, the devicecan include a housing having the sensor, the controller, and the motordisposed therein. For yet another example, the device can include ahousing having the sensor and the controller disposed therein, and themotor can be located outside the housing and can be in electroniccommunication with the cutting element.

In some embodiments, the sensor can be configured to sense a referencetissue impedance of the tissue engaged between the facing engagementsurfaces. When the cutting element is translating through the endeffector and the sensed tissue impedance becomes greater than thereference tissue impedance, the controller can be configured to changethe output of the motor so as to speed up the translation of the cuttingelement through the end effector. When the cutting element istranslating through the end effector and the sensed tissue impedancebecomes less than the reference tissue impedance, the controller can beconfigured to change the output of the motor so as to slow down thetranslation of the cutting element through the end effector.

In some embodiments, the surgical device can include a second sensorconfigured to sense a longitudinal position of the cutting elementrelative to the end effector, and the controller can be configured tochange the output of the motor based at least in part on the sensedlongitudinal position of the cutting element relative to the endeffector. The cutting element can be configured to translate through theend effector from a start position to an end position, and thecontroller can be configured to change the output of the motor inresponse to the second sensor sensing that the cutting elementtranslates through an intermediate position that is between the startand end positions along a longitudinal axis of the end effector.

In some embodiments, the surgical device can include a second sensorconfigured to sense a longitudinal position of the cutting elementrelative to the end effector, and the the controller can configured toclose the first and second jaws at a rate proportional to the sensedlongitudinal position.

In another embodiment, a surgical device is provided that includes aproximal handle portion operatively coupled to a motor, a shaftextending distally from the handle portion, and an end effector at adistal end of the shaft. The end effector can be configured to engagetissue. The surgical device can also include a cutting elementconfigured to move longitudinally through the end effector from a startposition to an end position. The motor can be configured to providepower that causes the movement of the cutting element from the startposition to the end position. The surgical device can also include asensor configured to sense a position of the cutting element relative tothe end effector, and a controller configured to adjust the powerprovided by the motor during the movement of the cutting element basedat least in part on the sensed position of the cutting element relativeto the end effector.

The surgical device can have any number of variations. For example, thecontroller can be configured to prevent the power from causing a forceof the cutting element moving longitudinally through the tissue toexceed a maximum threshold amount of force in response to the sensorsensing the position of the cutting element as being at or beyond apredetermined intermediate position that is between the start and endpositions. The force can be based on one or more of a current of themotor, a voltage of the motor, revolutions per minute (RPM) of themotor, and drivetrain of the motor. For another example, the controllercan be configured to close the end effector at a rate proportional tothe sensed position. For another example, the surgical device caninclude a second sensor configured to sense an impedance of the tissueengaged by the end effector. The controller can be configured to adjustthe power provided by the motor during the movement of the cuttingelement based at least in part on the sensed tissue impedance, therebyadjusting a velocity of the cutting element moving longitudinallythrough the end effector.

In another embodiment, a surgical device is provided that includes aproximal portion configured to be handheld, and a distal portionincluding a working end configured to be advanced into a body of apatient. The working end can be configured to be movable relative to theproximal portion using electronic power supplied to the surgical devicefrom a motor. The device can also include a cord extending from theproximal handle portion such that a free end of the cord is external tothe proximal handle portion. The free end of the cord can be configuredto be selectively operatively connected to and not operatively connectedto a generator. The device can also include a power source configured toprovide power to the motor. The power source can be external to theproximal handle portion and can be attached to the cord adjacent thefree end.

The device can vary in any number of ways. For example, the power sourcecan be removably and replaceably attached to the cord such that thepower source can be detached from the cord so as to allow either thepower source to be reattached thereto or for a second power source to beattached to the cord adjacent the free end. For another example, thedevice can include a power source housing fixedly attached to the cordadjacent the free end. The power source can be configured to beremovably and replaceably disposed in the power source housing.

In another embodiment, a surgical device is provided that includes aproximal handle portion, a shaft extending distally from the handleportion, an end effector at a distal end of the shaft, the end effectorbeing configured to engage tissue, an actuator configured to be actuatedso as to cause the end effector to move relative to the shaft, and acord extending from the proximal handle portion. The cord can beconfigured to operatively couple to a generator configured to providepower to the surgical device when the cord is coupled thereto. Thedevice can also include a power source on the cord and external to theproximal handle portion.

The device can vary in any number of ways. For example, the power can beprovided by the generator in response to the actuation of the actuator.The power provided by the generator can provide all the power necessaryto move the end effector relative to the shaft in response to theactuation of the actuator. The power provided by the generator canprovide a first partial portion of the power necessary to move the endeffector relative to the shaft in response to the actuation of theactuator, a second partial portion of the power necessary to move theend effector relative to the shaft in response to the actuation of theactuator being manual power provided by a user. For another example, thepower source can be removably and replaceably attachable to the cord.For yet another example, the device can include a power source housingfixedly attached to the cord, and the power source can be configured tobe removably and replaceably disposed in the power source housing. Forstill another example, the power source can include a battery. Foranother example, the cord can have a first end attached to the proximalhandle portion and a second end configured to removably and replaceablyattach to the generator, and the power source can be on the cordproximate the second end. For still another example, the device caninclude a cutting element configured to move longitudinally through theend effector from a start position to an end position, and the generatorcan be configured to provide at least a portion of power that causes themovement of the cutting element from the start position to the endposition. The device can also include a sensor configured to sense aposition of the cutting element relative to the end effector. The devicecan also include a controller configured to adjust the power provided bythe generator during the movement of the cutting element based at leastin part on the sensed position of the cutting element relative to theend effector.

In another embodiment, a surgical device is provided that includes aproximal portion including a first actuator and a second actuator, anelongate shaft extending distally from the proximal portion, and firstand second jaws at a distal end of the elongate shaft. The first andsecond jaws can be configured to clamp tissue therebetween. The devicecan also include an energy applicator configured to apply energy to thetissue clamped between the first and second jaws. The first actuator canbe configured to be actuated so as to cause the energy applicator toapply the energy to the clamped tissue. The device can also include acutting element configured to translate through the clamped tissue so asto cut the tissue. The second actuator can be configured to be actuatedso as to simultaneously cause the energy applicator to apply the energyto the clamped tissue and the cutting element to translate through theclamped tissue so as to cut the tissue. The first actuator can beconfigured to be actuated so as to cause the energy applicator to applythe energy to the clamped tissue without causing the cutting element totranslate through the clamped tissue so as to cut the tissue.

The device can have any number of variations. For example, each of thefirst and second actuators can be configured to be actuated independentof the other of the first and second actuators. For another example, thesecond actuator can be configured to, in response to actuation thereof,simultaneously begin causing the energy applicator to apply the energyto the clamped tissue and the cutting element to translate through theclamped tissue so as to cut the tissue. For yet another example, thesecond actuator can be configured to, in response to actuation thereof,begin causing the energy applicator to apply the energy to the clampedtissue in response to reaching a first predetermined threshold ofactuation and causing the cutting element to translate through theclamped tissue so as to cut the tissue in response to reaching a secondpredetermined threshold of actuation that is after the firstpredetermined threshold of actuation. The first predetermined thresholdof actuation can include a first amount of force applied to the firstactuator and the second predetermined threshold of actuation can includea second amount of force applied to the first actuator. The secondamount of force can be greater than the first amount of force. Foranother example, the proximal portion can include a stationary member,the first actuator can include a first movable member being actuatableby being movable relative to the stationary member, and the secondactuator can include a second movable member being actuatable by beingmovable relative to the stationary member. The first movable member caninclude a button, and the second movable member can include a firstmovable trigger. For yet another example, each of the first and secondactuators can include one of a movable trigger, a button, a lever, and aswitch. For still another example, the energy can include radiofrequencyenergy. For another example, the device can include a third actuatorconfigured to be actuated so as to cause at least one of the first andsecond jaws to move so as to clamp the tissue between the first andsecond jaws. The third actuator can be configured to be actuatedindependent of each of the first and second actuators. Each of the firstand second actuators can be configured to be actuated independent of theothers of the first, second, and third actuators. The third actuator canbe configured to be actuated so as to cause at least one of the firstand second jaws to move so as to unclamp the tissue between the firstand second jaws, and the third actuator can be configured to be actuatedso as to unclamp the tissue between the first and second jaws after theactuation of the first actuator so as to cause the energy applicator toapply the energy to the clamped tissue without the second actuatorhaving been actuated. For another example, the device can include amotor configured to provide an output that drives the translation of thecutting element through the clamped tissue.

In another embodiment, a surgical device is provided that in oneembodiment includes a proximal portion, an elongate shaft extendingdistally from the proximal portion, a working element at a distal end ofthe elongate shaft, the working element being configured to grasp tissuetherewith, an energy applicator configured to apply energy to the tissuegrasped by the working element, and a cutting element configured to moverelative to the working element and cut the tissue grasped by theworking element. The surgical device can have first and second modes,the first mode in which the energy is applied without the cuttingelement moving relative to the working element, and the second mode inwhich the energy is applied simultaneously with the cutting elementmoving relative to the working element and cutting the tissue grasped bythe working element.

The device can vary in any number of ways. For example, the surgicaldevice can have a third mode in which the working element grasps thetissue, the cutting element cuts the grasped tissue, the working elementreleases the cut tissue, and the energy applicator does not apply energyto the tissue before or after the tissue is cut. For another example,the device can include a motor configured to provide an output thatdrives the movement of the cutting element relative to the workingelement. For yet another example, the working element can include a pairof opposed jaws configured to grasp the tissue therebetween.

In another embodiment, a surgical device is provided that includes aproximal portion, an elongate shaft extending distally from the proximalportion, and an end effector at a distal end of the elongate shaft. Theend effector can include first and second jaws configured to grasptissue between facing engagement surfaces thereof. The end effector canbe configured to move between a closed position, in which a minimum gapexists between the facing engagement surfaces when no tissue is beinggrasped by the end effector, and an open position in which another,larger gap exists between the facing engagement surfaces. The device canalso include a first conductive member configured to directly engage thegrasped tissue and apply energy to the grasped tissue, and a secondconductive member configured to directly engage the grasped tissue whenthe first conductive member applies the energy thereto. The secondconductive member can be configured to maintain the minimum gap when thefirst and second jaws are in the closed position.

The device can vary in any number of ways. For example, when the minimumgap exists between the facing engagement surfaces, the second conductivemember can be configured to directly engage the facing engagementsurface of the first jaw without directly engaging the facing engagementsurface of the second jaw. For another example, the first jaw can bemovable relative to the elongate shaft, to the second jaw, and to thefirst and second conductive members so as to move the end effectorbetween the open and closed positions. For still another example, thefirst and second jaws can each be movable relative to the elongate shaftso as to move the end effector between the open and closed positions.For yet another example, the first and second conductive members caneach be part of the same one of the first and second jaws. For anotherexample, the device can include a third conductive member configured todirectly engage the grasped tissue and apply energy to the graspedtissue, the first conductive member being on the facing engagementsurface of the first jaw and the third conductive member being on thefacing engagement surface of the second jaw. The second conductivemember can be attached to the first jaw and extend from the facingengagement surface of the first jaw in a direction toward the facingengagement surface of the second jaw.

In another embodiment, a surgical device is provided that includes aproximal handle portion, an elongate shaft extending distally from theproximal handle portion, a first jaw at a distal end of the elongateshaft, the first jaw having a first tissue engagement surface, and asecond jaw at the distal end of the elongate shaft. The second jaw canhave a second tissue engagement surface At least one of the first andsecond jaws can be movable relative to the elongate shaft to facilitateclamping of tissue between the first and second tissue engagementsurfaces. The device can also include a first conductive member formingat least a portion of the first tissue engagement surface. The firstconductive member can be configured to apply energy to the tissueclamped between the first and second tissue engagement surfaces. Thedevice can also include a second conductive member extending from thefirst tissue engagement surface in a direction toward the second tissueengagement surface. The second conductive member can be configured tocontact the first tissue engagement surface so as to maintain a minimumamount of space between the first and second tissue engagement surfaces,and the second conductive member can be configured to not conduct energywhen the first conductive member is applying the energy.

The device can have any number of variations. For example, the firsttissue engagement surface can have a plurality of holes formed therein,and the second conductive member can include a plurality of conductivemembers. Each of the plurality of holes can have one of the plurality ofconductive members extending therethrough. For another example, thefirst and second conductive members can not be in direct contact withone another. For yet another example, the device can include a thirdconductive member forming at least a portion of the second tissueengagement surface. The third conductive member can be configured toapply energy to the tissue clamped between the first and second tissueengagement surfaces. The second conductive member can be configured tocontact the third conductive member so as to maintain the minimum amountof space between the first and second tissue engagement surfaces. Foranother example, the device can include a cutting element configured totranslate along the first and second jaws so as to cut the tissueclamped between the first and second tissue engagement surfaces. Thecutting element can be formed of a conductive material. For yet anotherexample, the second conductive member can include a plurality of posts.For another example, material forming the second conductive member canbe unitary with material forming the first jaw.

In another embodiment, a surgical device is provided that includes firstand second jaws configured to grasp tissue therebetween. The first andsecond jaws can be configured to move between a fully closed positionwhen no tissue is being grasped by the first and second jaws, in whichfacing tissue engagement surfaces of the first and second jaws are notin direct contact and in which a first non-zero distance exists betweenthe facing engagement surfaces, and an open position when no tissue isbeing grasped by the first and second jaws, in which a second non-zerodistance exists between the facing engagement surfaces. The secondnon-zero distance can be greater than the first non-zero distance. Thedevice can also include one or more electrodes configured to applyenergy to the grasped tissue, and one or more conductive spacersconfigured to maintain the first non-zero distance between the first andsecond jaws when the first and second jaws are in the fully closedposition.

The device can vary in any number of ways. For example, the one or moreconductive spacers can be configured to directly contact the graspedtissue when the energy is applied thereto. For another example, the oneor more conductive spacers can each be spaced a distance apart from theone or more electrodes. For yet another example, the device can includea proximal handle portion, and an elongate shaft extending distally fromthe proximal handle portion. The first and second jaws can be attachedto a distal end of the elongate shaft.

In another aspect, a surgical system is provided that in one embodimentincludes a handheld surgical device that includes a proximal handleportion and a distal end effector configured to engage tissue, a motorconfigured to provide an output that causes the distal end effector tomove relative to the proximal handle portion, a wire extending outsidethe proximal handle portion and being configured to be selectivelyattached to and detached from the motor by being reattachable thereto,and a power source attached to the wire at a location outside theproximal handle portion and being configured to provide power to themotor when the wire is attached to the motor. The power provided to themotor can allow the motor to provide the output.

The system can have any number of variations. For example, the wire canhave a first end attached to the handheld surgical device and a secondend configured to be selectively attached to and detached from the motorby being reattachable thereto, and the power source can be adjacent tothe second end. For another example, the system can include a powersource housing fixedly attached to the wire. The power source can beconfigured to be removably and replaceably disposed in the power sourcehousing. For yet another example, the system can include a cuttingelement configured to move longitudinally through the distal endeffector, and the motor can be configured to provide power that causesthe movement of the cutting element. For another example, the endeffector can include first and second jaws configured to move between anopen position and a closed position, and the motor can be configured toprovide power that causes the movement between the open and closedpositions. For still another example, the motor can be located entirelyoutside the proximal handle portion.

In another aspect, a surgical method is provided that in one embodimentincludes engaging tissue with first and second jaws of a surgicaldevice, receiving an input from a user that causes a motor of the deviceto provide power that causes a cutting element to move along the firstand second jaws so as to cut the engaged tissue, measuring an impedanceof the engaged tissue in real time with the cutting element moving alongthe first and second jaws, and changing an amount of the power providedby the motor based at least in part on the measured tissue impedance.

The surgical method can vary in any number of ways. For example, thesurgical method can include sensing a longitudinal position of thecutting element relative to the first and second jaws, and performing atleast one of changing the amount of the power provided by the motorbased at least in part on the sensed longitudinal position of thecutting element relative to the first and second jaws, and closing thefirst and second jaws at a rate proportional to the sensed position.

In another embodiment, a surgical method is provided that includesclamping tissue between opposed jaws at a distal end of a surgicalinstrument, and executing operation of the surgical instrument in one offirst, second, and third modes of operation in which the surgicalinstrument is configured to operate. The first mode can include applyingenergy to the clamped tissue and then unclamping the tissue between theopposed jaws without the clamped tissue having been cut. The second modecan include applying energy to the clamped tissue, cutting the clampedtissue after the energy has been applied, and unclamping the tissuebetween the opposed jaws after the tissue has been cut. The third modecan include simultaneously applying energy to the clamped tissue andcutting the clamped tissue, and then unclamping the tissue between theopposed jaws.

The method can vary in any number of ways. For example, the energy caninclude radiofrequency energy. For another example, the second mode canalso include simultaneously applying energy to the clamped tissue andcutting the clamped tissue.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a side, partially transparent schematic view of one embodimentof a powered surgical device;

FIG. 2 is a perspective, partially transparent schematic view of adistal end of the surgical device of FIG. 1;

FIG. 3 is a perspective view of one embodiment of a compression memberconfigured to translate longitudinally along an end effector;

FIG. 4 is a side view of another embodiment of a powered surgicaldevice;

FIG. 5 is a perspective view of a distal end of the surgical device ofFIG. 4;

FIG. 6 is a side partial view of the surgical device of FIG. 4 showingactuation of a closure trigger of the device to move the closure triggerclosed;

FIG. 7 is a side view of the surgical device of FIG. 6, with the closuretrigger closed, showing actuation of an energy actuator of the device;

FIG. 8 is a side view of the surgical device of FIG. 6, with the closuretrigger closed, showing actuation of a firing actuator of the device;

FIG. 9 is a side view of the surgical device of FIG. 6 showing actuationof the closure trigger of the device to move the closure trigger open;

FIG. 10 is a side, partially transparent schematic view of anotherembodiment of a powered surgical device;

FIG. 11 is a graph showing one embodiment of a continuum of cuttingelement velocity versus user input and cutting element distance;

FIG. 12 is a graph showing one embodiment of maximum cutting elementforce versus cutting element distance in length and in counts;

FIG. 13A is a graph showing one embodiment of cutting element velocityversus cutting element distance in length and in counts;

FIG. 13B is a graph showing maximum cutting element speed versus motorcurrent for the embodiment of FIG. 13A;

FIG. 13C is a table showing inputs and outputs for the embodiment ofFIG. 13A;

FIG. 14 is a graph showing one embodiment of time for a cutting elementto traverse jaws of a powered surgical device versus cutting elementload;

FIG. 15 is a graph showing one embodiment of tissue impedance versustime for a powered surgical device;

FIG. 16A is a flowchart showing one embodiment of a surgical methodusing a powered surgical device;

FIG. 16B is a continuation of the flowchart of FIG. 16A;

FIG. 16C is a continuation of the flowchart of FIG. 16B;

FIG. 16D is a continuation of the flowchart of FIG. 16C;

FIG. 17 is a side cross-sectional view of an embodiment of an endeffector including at least one stop member;

FIG. 18 is a perspective partial view of another embodiment of an endeffector including at least one stop member;

FIG. 19 is a cross-sectional view of a portion of an embodiment of a jawof an end effector including at least one stop member; and

FIG. 20 is a schematic view of embodiments of power source arrangementsfor an embodiment of a surgical device.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the anatomy of the subject in which the systems and devices will beused, the size and shape of components with which the systems anddevices will be used, and the methods and procedures in which thesystems and devices will be used.

Various exemplary methods and devices for controlling motorized surgicaldevices are provided. In general, the methods and devices can allow asurgical device to grasp and cut tissue. In some embodiments, the devicecan include at least one sensor and a motor, and an output of the motorcan be configured to be adjusted based at least in part on an outputfrom the at least one sensor. The output of the motor can be configuredto provide power for translation of a cutting element along an endeffector of the device. Adjusting the motor's output can cause thecutting element to translate through the end effector at differentspeeds, thereby allowing the cutting element to cut through tissue beinggrasped by the end effector at different speeds. The different speedscan facilitate the cutting of different tissues by the cutting element.Thus, thick, tough, irradiated, and/or calcified tissues can be moreeasily cut by the cutting element via adjustment of the motor's output.In general, motorized surgical devices can allow the application ofsuperior compression to tissue while enabling the sealing of toughtissues, as well as delicate tissues. The device can be handheld, andthe motor can be on-board the handheld device, or the motor can beexternal to the handheld device and be in electronic communicationtherewith so as to be configured to provide an output to the device fromthe external location. Similarly, the sensor can be on-board thehandheld device, or the sensor can be external to the device and be inelectronic communication therewith so as to be configured to senseparameter(s) local to the device.

FIG. 1 illustrates one embodiment of a surgical device 100 configured tograsp and cut tissue. The surgical device 100 can include a proximalhandle portion 10, a shaft portion 12, and an end effector 14 configuredto grasp tissue. The proximal handle portion 10 can be any type ofpistol-grip or other type of handle known in the art that is configuredto carry various actuators, such as actuator levers, triggers orsliders, configured to actuate the end effector 14. As in theillustrated embodiment, the proximal handle portion 10 can include aclosure grip 20 and a stationary grip 22. Movement of the closure grip20 toward and away from the stationary grip 22, such as by manualmovement by a hand of a user, can adjust a position of the end effector14. The shaft portion 12 can extend distally from the proximal handleportion 10 and can have a bore (not shown) extending therethrough. Thebore can carry mechanisms for actuating the end effector 14, such as ajaw closure tube and/or a drive shaft. As discussed further below, oneor more sensors (not shown) can be coupled to the surgical device 100and can be configured to sense data that can be used in controlling anoutput of the device's motor 32.

The end effector 14 can have a variety of sizes, shapes, andconfigurations. As shown in FIGS. 1 and 2, the end effector 14 caninclude a first, upper jaw 16 a and a second, lower jaw 16 b eachdisposed at a distal end 12 d of the shaft portion 12. One or both ofthe upper and lower jaws 16 a, 16 b can be configured to close orapproximate about a longitudinal axis L₁ of the end effector 14. Both ofthe jaws 16 a, 16 b can be moveable relative to the shaft portion 12such that the end effector 14 can be moved between open and closedpositions, or only one the upper and lower jaws 16 a, 16 b can beconfigured to move relative to the shaft portion 12 and to the other ofthe jaws 16 a, 16 b so as to move the end effector 14 between open andclosed positions. When the end effector 14 is in the open position, thejaws 16 a, 16 b can be positioned at a distance apart from one anotherwith space therebetween. As discussed further below, tissue can bepositioned within the space between the jaws 16 a, 16 b. When the endeffector 14 is in the closed position, a longitudinal axis of the upperjaw 16 a can be substantially parallel to a longitudinal axis of thelower jaw 16 b, and the jaws 16 a, 16 b can be moved toward one anothersuch that the distance therebetween is less than when the end effector14 is in the open position. In some embodiments, facing engagementsurfaces 18 a, 18 b of the jaws 16 a, 16 b can be in direct contact withone another when the end effector 14 is in the closed position such thatthe distance between is substantially zero. In the illustratedembodiment, the upper jaw 16 a is configured to pivot relative to theshaft portion 12 and relative to the lower jaw 16 b while the lower jaw16 b remains stationary. In the illustrated embodiment, the jaws 16 a,16 b have a substantially elongate and straight shape, but a personskilled in the art will appreciate that one or both of the jaws 16 a, 16b can be curved along the longitudinal axis L₁ of the end effector 14.The longitudinal axis L₁ of the end effector 14 can be parallel to andcoaxial with a longitudinal axis of the shaft portion 12 at least whenthe end effector 14 is in the closed configuration, and if the endeffector 14 is configured to articulate relative to the shaft portion12, when the end effector 14 is not articulated relative to the shaftportion 12.

The jaws 16 a, 16 b can have any suitable axial length L_(A) forengaging tissue, where the axial length L_(A) is measured along thelongitudinal axis L₁ of the end effector 14, as shown in FIG. 2. Theaxial length L_(A) of the jaws 16 a, 16 b can also be selected based onthe targeted anatomical structure for transection and/or sealing. If anexemplary embodiment, the jaws 16 a, 16 b have a substantially equalaxial length L_(A).

The jaws 16 a, 16 b can have any number and any combination of featuresconfigured to facilitate grasping tissue between the facing surfaces 18a, 18 b of the jaws 16 a, 16 b. The first and second engagement surfaces18 a, 18 b can each be configured to directly contact tissue. Either oneor both of the engagement surfaces 18 a, 18 b can include one or moresurface features formed thereon that can help secure the tissue thereon.The one or more surface features can facilitate grasping of tissue, canbe configured to increase friction between the tissue and the engagementsurfaces 18 a, 18 b of the jaws 16 a, 16 b without tearing or otherwisedamaging the tissue in contact with such surface features, and/or canfacilitate forming substantially smooth, uniform layers of tissue toimprove tissue effect. Examples of the surface features can includeteeth, ridges, and depressions. In the illustrated embodiment, as shownin FIG. 2, the jaws 16 a, 16 b each include a plurality of teeth 26positioned along an axial length of both of the engagement surfaces 18a, 18 b.

One or both of the first and second jaws 16 a, 16 b can include one ormore features configured to interact with a compression member (notshown) configured to apply compressive forces on tissue. For example,the first and second jaws 16 a, 16 b can include first and secondrecessed slots (not shown) that can receive portions of a compressionmember and act as a track to direct movement of the compression member.As another example, the first and second recessed slots can beconfigured to receive portions of a cutting element, as discussedfurther below.

The compression member can have various sizes, shapes, andconfigurations. The compression member can have an elongate shape andcan be moveable proximally and distally along the longitudinal axis L₁of the end effector 14. One embodiment of a compression member 28 isillustrated in FIG. 3. As shown, the compression member 28 can have aproximal end 28 p, a distal end 28 d, and a medial portion 28 mextending therebetween. The proximal end 28 p and the medial portion 28m of the compression member 28 can be sized and shaped to reciprocatewithin the shaft portion 12 of the device 100. The distal end 28 d ofthe compression member 28 can be sized and shaped to interact with thejaws 16 a, 16 b of the end effector 14. A longitudinal axis L_(C) of thecompression member 28 can be parallel to and coaxial with thelongitudinal axis L₁ of the end effector 14, though other configurationsare possible. The compression member 28 can be actuatable from theproximal handle portion 10 of the device 100 by a first, firing actuator24 that is operatively coupled to the proximal end 28 p of thecompression member 28, such as via a depressible button 24, shown inFIG. 1. Other examples of the firing actuator that can actuate thecompression member include a lever, a knob, a switch, and a trigger. Ingeneral, the firing actuator 24 can be configured to be manuallymanipulated by a user to cause actuation of one or more other deviceelements, such as the compression member 28.

The compression member 28 can include a connecting portion 30 c andupper and lower flanges 30 a, 30 b, thus providing an “I”cross-sectional shape for the compression member 28. The compressionmember 28 having this “I” cross-sectional shape is thus also referred toherein as an I-Blade. As in the illustrated embodiment, the upper andlower flanges 30 a, 30 b can be positioned substantially perpendicularto the connecting portion 30 c to form the “I” cross-sectional shape.The upper and lower flanges 30 a, 30 b can be sized and shaped to allowthe upper and lower flanges 30 a, 30 b to slide in the recessed slots inthe upper and lower jaw 16 a, 16 b, respectively. This sliding contactof lateral edges of the flanges 30 a, 30 b and sides of each of therecessed slots can prevent lateral flexing of the jaws 16 a, 16 b. Thecompression member 28 can have various other configurations. Forexample, the upper flange 30 a can have a width that is greater than awidth of the lower flange 30 b, the widths being measured in a directionperpendicular to the longitudinal axis L₁ of the end effector 14.

The compression member 28 can form a distal tip of a drive shaft thatmoves through the end effector 14 such that only a distal portion of thedrive shaft includes the compression member 28. A longitudinal length ofthe compression member 28 can be less than a longitudinal length of theend effector 14 such that the distal tip that includes the compressionmember 28 can move through the end effector 14 without the compressionmember 28 extending along the entire longitudinal length of the endeffector 14. Alternatively, the compression member 28 can be along anentire longitudinal length of the drive shaft. The compression member 28can thus extend along the end effector's entire longitudinal length whenthe compression member 28 is in its distal-most position relative to theend effector 14.

The device 100 can include a cutting element (not shown) configured tocut tissue captured between the jaws 16 a, 16 b. The cutting element canhave various sizes, shapes, and configurations. Examples of the cuttingelement include a knife blade and a sharp edge. The cutting element canbe sized and shaped to cut various thicknesses and types of tissuepositioned between the jaws 16 a, 16 b of the end effector 14. In anexemplary embodiment, the cutting element can be positioned at thedistal end 28 d of the compression member 28, such as by being formed onthe connecting portion 30 c of the compression member 28 as an integralpart thereof, e.g., as a sharpened edge thereof, or as a member attachedthereto, e.g., a blade mounted thereon. The cutting element can have asharp or serrated edge configured to transect tissue. In an exemplaryembodiment, the cutting element can be recessed relative to distal endsof upper and lower flanges 30 a, 30 b of the compression member 28,which can allow compression to occur prior to the cutting elementcutting tissue as the compression member 28 traverses through the jaws16 a, 16 b. In another embodiment, the cutting element can be configuredsuch that it is not attached to the compression member 28, such that thecutting element can be configured to advance and retract relative to thejaws 16 a, 16 b so as to cut tissue sandwiched therebetween withoutapplying compression to the tissue. In this embodiment, the device 100can include a separate compression member so that tissue engaged by thejaws 16 a, 16 b can still be compressed.

The surgical device 100 can include a second, closure actuatorconfigured to open and close the jaws 16 a, 16 b of the end effector 14.Manipulation of the closure actuator, e.g., manual manipulation by auser, can cause the end effector 14 to move between the open and closedpositions. In other words, manipulation of the closure actuator cancause one or both of the jaws 16 a, 16 b to pivot or otherwise move, asdiscussed above, so as to allow the jaws 16 a, 16 b to engage tissue,move anatomical structures, and/or perform other surgical functions. Theclosure actuator can have various sizes, shapes, and configurations. Asin the illustrated embodiment, the closure actuator can include theclosure grip 20 and the stationary grip 22. The closure grip 20 can bemoveable toward and away from stationary grip 22, such as via pivoting.The closure grip 20 can have a first position in which the closure grip20 is angularly offset from the stationary grip 22 and in which the jaws16 a, 16 b are open. The closure grip 20 can have a second position thatis different from the first position and in which the closure grip 20 ispositioned adjacent to or substantially in contact with the stationarygrip 22 and in which the jaws 16 a, 16 b can engage tissue and apply aforce to tissue disposed therebetween. The closure grip 20 can be biasedto the first position with the jaws 16 a, 16 b being open, as shown inFIG. 1.

The closure grip 20 can be configured to move the jaws 16 a, 16 bbetween the open and closed positions using manual or poweredcomponents. In a manually actuated embodiment, the closure grip 20 canbe coupled to a gear that interacts with a rack extending in the handleportion 10, and manual movement of the closure grip 20 toward thestationary grip 22 can move the rack distally toward the end effector14, causing a force to be exerted onto the jaws 16 a, 16 b to close thejaws 16 a, 16 b. In a powered embodiment, as shown in the illustratedembodiment of FIG. 1, the device 100 can include a motor 32, acontroller 34, and a power source 36. The motor 32, the controller 34,and the power source 36 can be disposed in the proximal handle portion10. As will be appreciated by a person skilled in the art, the motor 32can include any type of motor (e.g., a rotary motor, etc.) configuredfor use with a surgical device, the controller 34 can include a varietyof devices configured to process signals (e.g., a microprocessor, acentral processing unit (CPU), a memory controller, etc.), and the powersource 36 can include a variety of devices configured to supply power toat least the controller 34 (e.g., a battery, etc.). In some embodiments,the power source can be off-board instead of on-board the device 100,such as by the device 100 being attachable via wired connection to anelectrical outlet or other power source. FIG. 20 shows embodiments ofpower source arrangements for an embodiment of a surgical deviceincluding a firing actuator in the form of a trigger, a cutting elementin the form of a knife, a motor, a gear box, an encoder, a motorcontroller, a microprocessor, switches, local power management,radiofrequency electrodes, a sensor, and a cord in the form of a cable.Referring again to FIG. 1, in some embodiments, the motor can beoff-board instead of on-board the device 100, such as by beingattachable via a wired connection to the motor. A manual movement of theclosure grip 20 can be configured to cause the controller 34 to transmita control signal to the motor 32, which can cause the jaws 16 a, 16 b toclose via movement of the compression member 28. The closure grip 20 caninteract with one or more locking features (not shown) configured tolock the closure grip 20 relative to the stationary grip 22. Forexample, the one or more locking features can automatically engage whenthe closure grip 20 substantially contacts the stationary grip 22, orthe locking feature can automatically engage at each position theclosure grip 20 is pivoted through, such as via ratcheting.

The firing and closure actuators can cooperate to allow selective firingand closing of the device 100. The firing actuator 24 can be configuredto be actuated to advance the cutting element through the end effector14, apply energy to tissue, or both. Depressing or pivoting the firingactuator 25 can activate various elements in the device, and therebycause one or more actions such as the compression member 28 and/or thecutting element advancing distally relative to the jaws 16 a, 16 b,and/or the compression member 28 and/or the cutting element retractingproximally relative to the jaws 16 a, 16 b, and/or energy beingdelivered to the jaws 16 a, 16 b. The firing actuator 24 can be inelectrical communication with the motor 32. The motor 32 can beoperatively coupled to the compression member 28 using, e.g., a gear andrack. As in this illustrated embodiment, activation of the motor 32 cancause advancement and/or retraction of the compression member 28.

Tissue can be difficult for the cutting element to cut, such as if thetissue is thick, tough, irradiated, and/or calcified. The tissue maythus not be able to be cut easily, or at all, if the cutting element isadvanced through the jaws 16 a, 16 b using manual power alone, e.g., ifthe cutting element is advanced through the jaws 16 a, 16 b in responseto the user's manual manipulation of a trigger handle. The motor 32 canbe configured to supplement force applied by the user to the firingactuator 24 so as to facilitate cutting tissue grasped by the jaws 16 a,16 b. In some embodiments, the motor 32 can provide all force used tocut tissue grasped by the jaws 16 a, 16 b in response to the user'sactuation of an actuator such as the firing actuator 24. In this way,the tissue can be cut without the user having to uncomfortably applyforce, e.g., if the user's hands are small such that the user cannoteasily actuate the firing trigger 24. Even when tissue is sufficientlythin and/or tender that manual power could cut the tissue, the motor 32providing some or all power to cut the tissue can relieve the user ofstrain. This can help reduce user discomfort, e.g., hand pain, that canresult from repeated cutting that is performed during a single procedureand/or that is performed in a series of surgical procedures performed bythe same user.

The device 100 can include at least one sensor (not shown), and themotor 32 can be configured to provide an output that is based at leastin part on an output from the sensor. The controller 34 can beconfigured to determine an amount of power to be provided by the motor32. The controller 34 can be configured to receive an output signal fromthe sensor, and based on the output signal from the sensor, cause themotor 32 to provide an output that supplies power to the cuttingelement. As discussed herein, the motor and the controller can not bedisposed within the surgical device, e.g., need not be disposed within ahandheld housing thereof. Instead, the motor and/or the controller canbe located in a separate interface or within a generator to which thesurgical device can be configured to operatively connect, as discussedfurther below.

The device 100 can be configured to provide energy, e.g., radiofrequency(RF) energy or therapeutic treatment energy, to tissue clamped betweenthe jaws 16 a, 16 b. The firing actuator 24 can be configured to causeapplication of the energy. The energy can be applied in a variety ofways, as will be appreciated by a person skilled in the art. Examples ofapplying energy are described further in US Pat. Pub. No. 2012/0078139entitled “Surgical Generator For Ultrasonic And Electrosurgical Devices”filed Oct. 3, 2011, US Pat. Pub. No. 2012/0116379 entitled “Motor DrivenElectrosurgical Device With Mechanical And Electrical Feedback” filedJun. 2, 2011, and U.S. application Ser. No. 14/166,194 entitled“Surgical Devices Having Controlled Tissue Cutting And Sealing” filed onJan. 28, 2014, which are hereby incorporated by reference in theirentireties.

As will be appreciated by a person skilled in the art, and discussed,for example, in previously mentioned US Pat. Pub. No. 2012/0078139entitled “Surgical Generator For Ultrasonic And Electrosurgical Devices”filed Oct. 3, 2011, RF energy is a form of electrical energy that may bein the frequency range of 300 kHz to 1 MHz. The device 100 can beconfigured to transmit low frequency RF energy through tissue, whichcauses ionic agitation, or friction, in effect resistive heating,thereby increasing the temperature of the tissue. Because a sharpboundary can be created between the affected tissue and the surroundingtissue, users of the device 100, e.g., surgeons and/or other medicalprofessionals, can operate on the tissue with a high level of precisionand control, without sacrificing un-targeted adjacent tissue. The lowoperating temperatures of RF energy can be useful for removing,shrinking, or sculpting soft tissue while simultaneously sealing bloodvessels. RF energy can work particularly well on connective tissue,which is primarily comprised of collagen and shrinks when contacted byheat. Heat generated by current flow, from the RF energy, through tissueto which the RF energy is applied can seal the tissue, e.g., formhaemostatic seals within the tissue and/or between tissues, and can thusbe particularly useful for sealing blood vessels, for example.

When the device 100 includes the cutting element configured to cuttissue clamped between the jaws 16 a, 16 b and is configured to applyenergy to tissue clamped between the jaws 16 a, 16 b so as to seal thetissue, the device 100 can be configured to separately cut and sealtissue clamped between the jaws 16 a, 16 b or can be configured tosimultaneously cut and seal tissue clamped between the jaws 16 a, 16 b.

FIG. 4 illustrates an embodiment of a surgical device 200 configured tocut and seal tissue clamped between first and second jaws 202 a, 202 bof the device's end effector 204. The device 200 can be configured toseparately cut and seal tissue and configured to simultaneously cut andseal tissue, with a user of the device 200 being able to decide whethercutting and sealing occurs separately or simultaneously. The device 200can generally be configured similar to the device 100 of FIG. 1. Thedevice 200, which is also shown in FIGS. 5-9, can include a motor 206(see FIG. 8), a closure trigger (also referred to herein as a “closuregrip”) 208, a firing actuator 210, a controller (not shown), a cuttingelement (not shown), a power connector 212 configured to attach to anexternal power source (not shown) such as a generator, an energyactuator 214, an elongate shaft 216 extending from a handle portion 218of the device 200, a sensor 220 (see FIG. 8), a knob 222 configured torotate so as to rotate the shaft 216 and the end effector 204 attachedthereto about a longitudinal axis of the shaft 216, the end effector 204at a distal end of the shaft 216, and a stationary handle 224. As shownin FIG. 5, the jaws 202 a, 202 b can be curved, e.g., have longitudinalaxes angularly offset from the longitudinal axis of the shaft 216, whichcan facilitate access to and/or clamping of tissue therebetween.

In this illustrated embodiment, the sensor 220 includes a positionswitch, although the sensor 220 can be another type of switch, such as aHall effect sensor, a spring pot, a potentiometer, an optical sensor, oran impedance sensor. The sensor 220 can be attached to the housing inany way, e.g., adhesive, welding, snap fits, screws, etc. The sensor 220is shown as being disposed within the handle portion 218 of the device200 proximate to the knob 222 in this illustrated embodiment, but thesensor 220 can be located elsewhere within the handle portion 218 oranother portion of the device 200. Additionally, although only onesensor 220 is shown in this illustrated embodiment, the device 200 caninclude a plurality of sensors 220, which can each be the same ordifferent type as others of the sensors 220.

As discussed further below, FIG. 4 shows the device 200 in a firstposition in which the motor 206 is off and in which the end effector 204is in an open position with the jaws 202 a, 202 b being open with adistance of space therebetween, FIG. 6 shows the device 200 being movedto a second position from the first position in which the closuretrigger 208 is being closed so as to move the end effector 206 to aclosed position where the jaws 202 a, 202 b are closed, FIG. 7 shows thedevice 200 in the second position, FIG. 8 shows the device 200 beingmoved from the second position to a third position in which the firingactuator 210 is being actuated and the motor 206 is being turned on, andFIG. 9 shows the device 200 being moved from the third position back tothe first position.

When the device 200 is in the first position, as shown in FIG. 4 andwith the closure trigger 208 in shadow in FIG. 6, the closure trigger208 is in an initial position in which the closure trigger 204 is notengaged with the sensor 220 and in which the jaws 202 a, 202 b are open.When the closure grip 208 is actuated, e.g., manually pulled proximallyby a user's hand toward the stationary handle 224 as shown by firstarrow A1 in FIG. 6, the jaws 201 a, 201 b can be closed so as to clamptissue therebetween, and the closure trigger 208 can activate the sensor220. The device 200 can be configured to lock the closure trigger 208 inthe closed position, such as by including a latch (not shown) on thestationary handle 224 configured to engage the closure trigger 208 whendrawn close enough thereto so as to lock the closure trigger 208 inposition relative to the stationary handle 224. Alternatively or inaddition, the closure trigger 208 can be manually held closed by a user.If the device 200 is not configured to lock the closure trigger 208 in afixed position relative to the stationary handle 226, the device'ssensor 220, e.g., a position sensor, can be configured to sense when theclosure trigger 208 is in close proximity of the stationary handle 224,so as to indicate that the closure trigger 220 is closed.

The closure trigger 208 can activate the sensor 220 by, e.g., pushingdown thereon as the closure trigger 208 is pulled toward the handlehousing from which the sensor 220 can extend. If the sensor 210 is not aposition switch, as mentioned above, the sensor 210 can be configured tobe activated in another way, such as by being within a certain thresholddistance of the closure trigger 208, as with a Hall effect sensor.Moving the closure trigger 204 can cause the jaws 208 a, 208 b to close,as will be appreciated by a person skilled in the art, such as by a jawclosure rod (not shown) being moved within the shaft 216. The user can“feel” the closure of the jaws 202 a, 202 b since the jaws 202 a, 202 bare being closed under manual, user power. This “feel” can allow for abetter user experience by allowing the user to know that the endeffector 204 is being closed, even if the end effector 204 is onlypartially visible or is not visible at all during end effector closure.

The activation of the sensor 220 can cause the sensor 220 to transmit asignal to the controller that indicates activation of the sensor 220.The sensor 220 being activated can indicate to the controller that themotor 206 can be turned on since the end effector 204 has been closed byactuation of the closure trigger 208.

The device 200 can be configured to prevent the energy from beingapplied until the sensor 220 is activated. In other words, until thesensor 220 is activated by closure of the closure trigger 208 so as toclose the end effector 204, the energy cannot be activated, even if thefiring actuator 210 is actuated. This can help provide safety bypreventing the energy from being applied and possibly damaging materialnear the jaws 202 a, 202 b before tissue to have the energy appliedthereto is clamped between the jaws 202 a, 202 b.

As shown in FIG. 7, the energy actuator 214 can be actuated, e.g., bybeing pressed by a user's finger as shown by a second arrow A2, so as tocause sealing of the tissue clamped between the jaws 202 a, 202 b byapplying energy to the tissue. As mentioned above, the device 200 caninclude a safety feature that can prevent the energy from being applieduntil the end effector 204 is closed even if the energy actuator 214 isactuated prior to jaw closure. The controller can be configured toconfirm that the sensor 220 has been activated before the energy isapplied. When the controller has confirmed the activation of the sensor210, the controller can cause the motor 202 to turn on. After theactuation of the energy actuator 214, the firing actuator 210 can beactuated, e.g., by being pressed by a user's finger as shown by a thirdarrow in FIG. 8, which can cause the cutting element to translate alongthe end effector 204 so as to cut the tissue clamped by the jaws 202 a,202 b. The tissue can thus be separately sealed and cut, with thesealing occurring before the cutting. Actuation of the firing actuator210 can be configured to cause energy to be applied, which can providefor additional sealing of the tissue during cutting of the tissue andhelp reduce bleeding. The tissue can thus be simultaneously cut andsealed, even if the tissue was previously sealed in response toactuation of the energy actuator 214. Alternatively, the device 200 canbe configured such that only actuation of the energy actuator 214 causesapplication of energy, with actuation of the firing actuator 210 causingtissue cutting without causing application of energy.

If a user chooses to not actuate the energy actuator 214 prior toactuation of the firing actuator 210, and the firing actuator 210 isconfigured to trigger application of energy, the tissue can be sealed inresponse to actuation of the firing actuator 210. In this way, thetissue can be simultaneously cut and sealed. Allowing the firingactuator 210 to trigger application of energy can help ensure that thetissue is sealed, such as if the user accidentally forgets to actuatethe energy actuator 214.

If the device 200 includes a compression member, which as mentionedabove can have the cutting element coupled thereto, the compressionmember can be configured to translate along the end effector 204 inresponse to actuation of the firing actuator 210. Actuation of thefiring actuator 210 can thus allow further closure of the end effector204 and allow for the jaws 202 a, 202 b to move closer together so as tomore securely grasp tissue held therebetween. The further closure of endeffector 204 can help compress the tissue between the jaws 202 a, 202 band allow the energy to be more pointedly directed to the tissue betweenthe jaws 202 a, 202 b, and/or can help prevent the energy from beingapplied to tissue before the jaws 202 a, 202 b have been sufficientlyclosed.

As shown in FIG. 9, after the tissue has been cut and sealed (separatelyand/or simultaneously), the closure trigger 208 can be released from itsclosed position so as to move back to its initial position, as shown bya third arrow A3. The closure trigger 208 can be released by beingmanually let go of by a user and/or by unlocking the closure trigger 208(e.g., unlatching the latch).

In some embodiments, the device 200 can be configured to adjust anamount of power provided by the motor 206 based on an amount of pressurethat a user applies to the firing actuator 210. The device 200 can beconfigured to detect when the user is applying a force to the actuatorabove a predetermined threshold of force, such as by using the sensor220 (e.g., a Hall effect sensor, a potentiometer, etc.), therebyindicating that the tissue grasped by the end effector 204 is thick,tough, irradiated, and/or calcified, that the tissue is more difficultto cut using the cutting element. When the detected force is equal to orgreater than the predetermined force, the motor 206 can be configured toprovide power as a supplement the user's applied force or to providepower in place of the user's applied force. The predetermined thresholdof force can be based on a human factor, e.g., how hard a human canactuate a trigger before it becomes too onerous. For example, thepredetermined threshold of force can be in a range of about 2 to 4pounds of hand grip force.

The device 200 can be configured to allow a user to manually advance thecutting element by actuating the firing actuator 210 without the motor206 providing power for the firing. If the user applies a force lessthan a predetermined force, then the motor 206 can stay off. If the userapplies a force equal to or greater than the predetermined force, thenthe motor 206 can be configured to be provide supplemental force forfiring. The motor 206 can be configured to switch between providingpower and not providing power based on the user's input force. The motor206 can be configured to turn on/off without any user input other thanthe user's input to the firing actuator 210. The device 200 can thus beconfigured to provide additional force for cutting if the user isapplying a certain amount of minimum force, thereby indicating that theuser is having difficulty applying adequate force to the actuator 210and/or that the tissue being cut is thick, tough, irradiated, and/orcalcified. Embodiments of devices configured to allow a user to actuatean actuator without a motor providing power are described in furtherdetail in U.S. application Ser. No. 14/166,244 entitled “Methods AndDevices For Controlling Motorized Surgical Devices” filed on Jan. 28,2014, which is hereby incorporated by reference in its entirety.

The device 200 can have a cord 211 extending therefrom. The cord 211 canhave a first terminal end (not shown) disposed within the handle portion218, e.g., within a proximal housing 213 configured to be handheld. Thefirst terminal end can be coupled to the motor 206, which can allowpower transmitted through the cord to be provided to the motor 206. Thecord 211 can have a second terminal end 215 at an end of the cord 211opposite the first terminal end. The power connector 212 can be locatedat the second terminal end 215, as in this illustrated embodiment.

The device 200 can also include a power source 217 attached to the cord211 at a location external to the handle portion 218, e.g., outside thehousing 213. The power source 217 in this illustrated embodimentincludes a lithium battery, but another type of power source can beused. The power source 217 can be in electronic communication with oneor more electronic components within the cord 211, e.g., with one ormore wires therein, so as to facilitate the power source's provision ofpower. The power source 217 can be configured to provide power to one ormore elements of the device 200, such as one or more components disposedat least partially within the housing 213, e.g., the motor 206, one ormore lights, etc. The device 200 can thus have an on-board power supply,e.g., the power source 217, as well as be configured to receive externalpower, e.g., when the power connector 212 is plugged into a generator,an AC outlet, etc. This versatility can provide for a better userexperience, as well as allow the device 200 to be used when an externalpower supply may not be available and/or when an on-board power supply217 is absent or is depleted of power.

The power source 217 can be located adjacent the second terminal end 219of the cord 211, and hence be located adjacent the power connector 212,as in this illustrated embodiment. The power source 217 being locatedadjacent the cord's second terminal end 219 can help the power source217 be out of the way when the handle portion 218 is being handled sincethe power source 217 can be located at a remote end 219 of the cord 211from the hand-holdable housing 213.

The device 200 can include a housing 219 attached to the cord 211 at alocation external to the handle portion 218, e.g., outside the housing213. The housing 219 can be configured to seat the power source 217therein, which can help stably and securely attach the power source 217to the device 200. The housing 219 can thus be located adjacent thesecond terminal end 219 of the cord 211, and hence be located adjacentthe power connector 212, similar to that discussed above regarding thepower source 217. The power source 217 can be removably and replaceablyseated in the housing 219, as in this illustrated embodiment, which canfacilitate recharging of the power source 217 if the power source 217 isrechargeable and/or can facilitate replacement of a spent power source217. In other embodiments, the power source 217 can be non-removablyseated within the housing 219, or non-removably attached to the cord 211without the housing 219. The housing 219 can have a size and shapecomplementary to a size and shape of power sources configured to beseated therein.

FIG. 10 illustrates another embodiment of a surgical device 300configured to cut and seal tissue clamped between first and second jaws302 a, 302 b of the device's end effector 304. The device 300 can beconfigured to separately cut and seal tissue and configured tosimultaneously cut and seal tissue, with a user of the device 300 beingable to decide whether cutting and sealing occurs separately orsimultaneously. The device 300 can generally be configured similar tothe device 100 of FIG. 1 and the device 200 of FIG. 4. The device 300can include a motor 306, a closure trigger 308, a firing actuator 310, acontroller 312, a cutting element (not shown), a power connector (notshown) configured to attach to an external power source (not shown), anenergy actuator 314, an elongate shaft 316 extending from a handleportion 318 of the device 300, a sensor 320 a, 320 b, the end effector304 at a distal end of the shaft 316, a stationary handle 324, and agear box 326 that can be operatively connected to the motor 306 andconfigured to transfer output from the motor 306 to the cutting element.In this illustrated embodiment, the controller 312 includes a printedcircuit board (PCB), the sensor 320 a includes a Hall effect sensor, andthe other sensor 320 b includes a Hall effect sensor. One of the jaws320 a in this illustrated embodiment includes an insulator 328configured to facilitate safe energy application to tissue clamped bythe end effector 304. Each of the jaws 302 a, 302 b can include aproximal slot 330 a, 330 b configured to facilitate opening and closingof the end effector 304, as will be appreciated by a person skilled inthe art. The device 300 can be configured to lock the closure trigger308 in the closed position, such as by the closure trigger 308 includinga latch 332 configured to engage a corresponding latch 334 on thestationary handle 324 when the closure trigger 308 is drawn close enoughthereto so as to lock the closure trigger 308 in position relative tothe stationary handle 324. The closure trigger latch 332 can beconfigured to be manually released by a user so as to unlock and releasethe closure trigger 308. A bias spring 336 included in the handleportion 318 can be coupled to the closure trigger 308 and cause theclosure trigger 308 to open, e.g., move away from the stationary handle324, when the closure trigger 308 is unlocked.

In some embodiments, an end effector of a surgical device, such as thedevice 100 of FIG. 1, the device 200 of FIG. 4, or the device 300 ofFIG. 10, can be configured to prevent shorting of one or more electrodescoupled thereto and configured to facilitate sensing of parameter(s) oftissue engaged by the end effector. In this way, the device can beconfigured to provide reliable sensed measurements and/or to not need tobe removed from within a patient during use to reset, replace and/orotherwise deal with shorted electrode(s). The end effector can beconfigured to prevent shorting of one or more electrodes by includingone or more stop members configured to ensure that facing tissueengagement surfaces of the end effector's jaws do not contact oneanother when the jaws are closed. In other words, the one or more stopmembers can be configured to ensure that a gap of space exists betweenthe jaws when the end effector is fully closed. In this way, one or moreelectrodes attached to one or both of the tissue engagement surfaces canbe configured to not contact one another so as to prevent theelectrode(s) from shorting.

FIG. 17 illustrates one embodiment of an end effector 600 configured toprevent shorting of one or more electrodes coupled thereto andconfigured to facilitate sensing parameter(s) of tissue engaged by theend effector 600. The end effector 600 can include first and second jaws604 a, 604 b and can generally be configured similar to the endeffectors 14, 204, 304 of the devices 100, 200, 300. In this illustratedembodiment, the first jaw 604 a is pivotally attached to the second jaw604 b at a pivot point 606 about which the first jaw 604 a can pivotallymove relative to the second jaw 604 b so as to allow the end effector600 to open and close.

A first tissue engagement surface 608 a of the first jaw 604 a caninclude a first electrode 602 a configured to contact tissue clampedbetween the jaws 604 a, 604 b. The first electrode 602 a is a singleelectrode in this illustrated embodiment, but the first electrode caninclude multiple electrodes. The first jaw 604 a can include a firstinsulator 610 a positioned between the material of the first jaw 604 a,e.g., stainless steel, titanium, etc., forming the first jaw 604 a, andthe first electrode 602 a. The first insulator 610 a can thus separatethe first jaw 604 a from the electrode 602 a. In this way, when thefirst jaw 604 a is formed of a conductive material, the first insulator610 a can prevent the electricity provided via the first electrode 602 amaterial from also being provided via the first jaw 604 a material. Thefirst jaw 604 a can thus be prevented from damaging tissue and/or othermatter outside the end effector 600 when the first electrode 602 a isapplying energy. A second tissue engagement surface 608 b of the secondjaw 604 b can include a second electrode 602 b configured to contacttissue clamped between the jaws 604 a, 604 b. The second electrode 602 bis in this illustrated embodiment includes multiple electrodes, but thesecond electrode can be a single electrode. The second jaw 604 b caninclude a second insulator 610 b positioned between the material of thesecond jaw 604 b, e.g., stainless steel, titanium, etc., forming thesecond jaw 604 b, and the second electrode 602 b. The second insulator610 b can thus separate the second jaw 604 b from the second electrode602 b. In this way, when the second jaw 604 b is formed of a conductivematerial, the second insulator 610 b can prevent the electricityprovided via the second electrode 602 b material from also beingprovided via the second jaw 604 b material. The second jaw 604 b canthus be prevented from damaging tissue and/or other matter outside theend effector 600 when the second electrode 602 b is applying energy.

The end effector 600 can include one or more stop members 612 configuredto ensure that the facing tissue engagement surfaces 608 a, 608 b do notcontact one another when the jaws 604 a, 604 b are closed. The endeffector 600 includes three stop members 612 in this illustratedembodiment, but the end effector 600 can include another number of stopmembers 612. The one or more stop members 612 can, as in thisillustrated embodiment, only be attached to the second jaw 604 b, e.g.,a stationary one of the jaws 604 a, 604 b and extend toward the firstjaw 604 a, e.g., a movable one of the jaws 604 a, 604 b. In this way,the one or more stop members 612 can be less likely to snag on, damage,and/or otherwise interfere with tissue and/or other matter adjacent theend effector 600 since the stop member(s) 612 can be stationary whiletissue is clamped between the tissue engagement surfaces 608 a, 608 b bythe movable jaws 604 a, 604 b. In other embodiments, one or more stopmembers can be attached only to a movable one of the jaws, to each of anend effector's stationary and movable jaws, or to each of an endeffector's two movable jaws.

The one or more stop members 612 can be connected to its associated jaw,the second jaw 604 b in this illustrated embodiment, at ground. Thisconnection can be accomplished, as in this illustrated embodiment, bythe one or more stop members 612 being integrally formed with the secondjaw 604 b, which as mentioned above can be formed from a material suchas metal.

A gap 614 of space can exist between the jaws 604 a, 604 b when the jaws604 a, 604 b are closed, as shown in FIG. 17. The one or more stopmembers 612 can provide for the gap 614 by causing the first engagementsurface 608 a to abut thereagainst a distance away from the secondengagement surface 608 b. The facing first and second electrodes 602 a,602 b on the first and second engagement surfaces 608 a, 608 b can thusbe prevented from contacting one another, which can help prevent theelectrodes 602 a, 602 b by shorting from contact thereof.

FIG. 18 illustrates another embodiment of an end effector 700 configuredto prevent shorting of one or more electrodes 702 coupled thereto andconfigured to facilitate sensing parameter(s) of tissue engaged by theend effector 700. The end effector 700 can generally be configuredsimilar to the end effectors 14, 204, 304 of the devices 100, 200, 300.The end effector 700 can include a first, movable jaw (not shown) and asecond, stationary jaw 704 similar to the first and second jaws 604 a,604 b of FIG. 17.

A tissue engagement surface 706 of the second jaw 704 can include theone or more electrodes 702 configured to contact tissue clamped betweenthe jaws. The one or more electrodes 702 in this illustrated embodimentincludes a single electrode. The second jaw 704 can include an insulator708 positioned between the material forming the second jaw 704, and theone or more electrodes 702. The tissue engagement surface 706 of thesecond jaw 704 can include teeth 708 t of the insulator 708 thereon. Theinsulator 708 can separate the second jaw 704 from the second electrode602 b. In this way, when the second jaw 704 is formed of a conductivematerial, the second insulator 610 b can prevent the electricityprovided via the one or more electrodes 702 material from also beingprovided via the second jaw 704 material. The second jaw 704 can thus beprevented from damaging tissue and/or other matter outside the endeffector 700 when the one or more electrodes 702 are applying energy,such as by preventing the second jaw 704 from being used to drill holesin tissue using energy applied therewith by pressing the second jaw 704against the tissue.

The end effector 700 can include one or more stop members 710 configuredto ensure that the facing tissue engagement surfaces of the end effector700 do not contact one another when the end effector is closed, e.g.,when the jaws are closed. The end effector 700 includes five stopmembers 710 in this illustrated embodiment, but the end effector 700 caninclude another number of stop members 710. The one or more stop members710 in this illustrated embodiment are only attached to the second jaw704 and extend toward the first jaw, but as discussed above, there canbe any number of stop member(s), and one or both jaws of an end effectorcan have stop member(s) attached thereto. The end effector 700 caninclude the one or more stop members 710 at multiple axial positionsalong a longitudinal length, as in this illustrated embodiment where theend effector includes a single stop member 710 at a distal end of theend effector 700, two stop members 710 at a proximal end of the endeffector 700, and two stop members 710 at an intermediate positionbetween the proximal and distal ends of the end effector 700. Havingstop members 710 at different axial positions along the end effector'slongitudinal length can help ensure that the gap exists along the endeffector's entire longitudinal length. The end effector 700 can, as inthis illustrated embodiment, include at least one of the stop members710 at or distally beyond a maximum distal endpoint of a cuttingelement's movement through the end effector 700.

FIG. 19 illustrates another embodiment of an end effector 800 configuredto prevent shorting of one or more electrodes 802 coupled thereto andconfigured to facilitate sensing parameter(s) of tissue engaged by theend effector 800. The end effector 800 can generally be configuredsimilar to the end effectors 14, 204, 304 of the devices 100, 200, 300.The end effector 800 can include a first, movable jaw (not shown) and asecond, stationary jaw 804 similar to the first and second jaws 604 a,604 b of FIG. 17. The end effector 800 can include one or more stopmembers 808.

As discussed above, the second jaws 604 b, 704 of the embodiments ofFIGS. 17 and 18 each have an insulator 610 b, 708 separating material ofthe second jaws 604, 704. Conversely, the second jaw 804 of theembodiment of FIG. 19 includes an insulator 806 that does not separatematerial of the second jaw 804 from material of the electrode(s) 802 ofthe second jaw 804. The second jaw 804 can thus be configured to drillholes in tissue using energy applied therewith by pressing the secondjaw 804 against the tissue. The insulator 806 can have an increasedthickness in a distal area 806 d thereof, which can help allow a distaltip 804 t of the second jaw 804 to drill the holes. A distal edge 804 eof the second jaw 804 can be moved outward to allow for the additionalinsulator material in the distal area 806 d. The amount of movement canvary, e.g., depending on width of a cutting element that translatesthrough the second jaw 804. For example, the amount of movement can be0.010″. Material can be removed from an area 812 at the distal tip 804 tto provide extra clearance between the second jaw 804 and the insulator806.

FIG. 11 illustrates a continuum of cutting element movement when asurgical device, such as the device 100 of FIG. 1, the device 200 ofFIG. 4, or the device 300 of FIG. 10, is configured to adjust an amountof power provided by a motor based on an amount of pressure that a userapplies to the device's firing actuator. In this illustrated embodiment,the cutting element includes a knife.

As shown in FIG. 11, A left hand edge of the continuum represents zerodisplacement of the firing actuator, corresponding to a zero voltagesignal system input. Application of force to the firing actuator cancause increased force applied to the sensor and hence increased voltage,corresponding to a “Reverse” zone in the continuum in which speed of themotor decreases from a first, maximum speed Max1 to a second, slowerspeed and the device's cutting element retracts, e.g., moves proximally.In one embodiment, the maximum speed Max1, e.g., maximum speed ofcutting element reverse movement, can be 0.3 in/sec. and the second,slower speed can be 0 in/sec. If the cutting element is attached to acompression member, the compression member can retract with the cuttingelement. The device can include a proximally located electrical limitswitch configured to signal the device's controller to stop the motorfrom further retracting the cutting element (and compression member, ifattached thereto) when the proximal electrical limit switch isactivated, e.g., when the proximal electrical limit switch closes. Anamount of user input between the maximum speed Max1 and the end of the“Reverse” zone can vary. In one embodiment, the amount of user input cancorrespond to about 0.1 in. finger travel on the firing actuator, whichcan correspond to ten counts of the sensor. The maximum speed Max1 andthe amount of user input can be preprogrammed into the device'scontroller.

Further application of force to the firing actuator can allow thecutting element (and compression member, if attached thereto) to haltretraction at any point along its stroke length. The stop is reflectedby the “Hold” zone in the continuum. The stop can help prevent operatorinduced oscillation. An amount of user input between a start and an endof the “Hold” zone can vary. In one embodiment, the amount of user inputcan correspond to about 0.1 in. finger travel on the firing actuator,which can correspond to ten counts of the sensor. The amount of userinput can be preprogrammed into the device's controller.

Entry into the “Hold” zone can trigger application of energy. In otherwords, using the embodiment shown in FIG. 11 as an example, energyapplication can begin at count 10. In some embodiments, the “Hold” zonecan include an energy application threshold (not shown) in which energycan begin to be applied at some point after entry into the “Hold” zone,at a point after count 10 in the embodiment shown in FIG. 11. In otherwords, application of a predetermined threshold amount of force afterthe start of the “Hold” zone can cause energy to be applied to tissuebeing grasped by the device. This application of energy before thecutting element begins to move, e.g., before entry into the “Forward”zone, can allow the tissue to be cooked to at least some degree beforecutting of the tissue begins, which can make the tissue easier to cut.The predetermined threshold amount can be a programmable variable suchthat it can be zeroed, e.g., entry into the “Hold” zone triggers energyapplication, or it can be mid-“Hold” zone, e.g., at a point after entryinto the “Hold” zone. This variable can allow the energy sequence toreset during actuation of the firing actuator and this variable can beindependent of a position of the cutting element relative to the endeffector. This variable can thus allow energy to be reapplied without afull homing of the cutting element.

Application of additional force to the firing actuator can move into the“Forward” zone of the continuum in which the controller can cause themotor to move from a first speed to a second, maximum, faster speed Max2in order to advance the cutting element (and compression member, ifattached thereto) distally. The maximum speed Max2, e.g., maximum speedof cutting element forward movement, can be less than the maximum speedMax1, which can allow the cutting element to move faster when beingretracted, e.g., when the cutting element is not cutting tissue. In oneembodiment, the maximum speed Max2, e.g., maximum speed of cuttingelement forward movement, can be 0.25 in/sec. and the first speed can be0 in/sec. The device can include a distally located limit switch (notshown) configured to signal the controller to stop the motor fromfurther advancing the compression member when the distal electricallimit switch is activated, e.g., when the distal electrical limit switchcloses. An amount of user input between the first speed and the end ofthe “Forward” zone can vary. In one embodiment, the amount of user inputcan correspond to about 0.4 in. finger travel on the firing actuator,which can correspond to forty counts of the sensor. The maximum speedMax2 and the amount of user input can be preprogrammed into the device'scontroller.

In the “Forward” and “Reverse” zones, the speed of the cutting elementcan be independent of a position of the cutting element relative to thetissue, and hence relative to the end effector grasping the tissue. Thespeed of the cutting element can be based solely upon the force appliedto the firing actuator, e.g., to relative to a position of the firingactuator. In other words, the speed of the cutting element can be basedupon how much a user has squeezed the firing actuator. This can help auser know how quickly the cutting element is moving by knowing how muchforce the user has applied to the firing actuator. In some embodiments,however, the cutting element's speed can be based upon how much forcethe user has applied to the firing actuator and one or more otherfactors, such as sensed impedance of the tissue and longitudinalposition of the cutting element relative to the end effector.

The different zones of the continuum shown in FIG. 11 can allow formovement of the cutting element (and compression member, if attachedthereto) proportional to a position of the firing actuator within thecontinuum, or the firing actuator can instead create a change in a logicstate of the device such that location of the firing actuator withinspecific portions of the continuum, e.g., within different ones of thezones, can creates a specific change in the logic state, such as havingthe motor change its speed from a slow rate to a fast rate once thefiring actuator reaches a specified point in the continuum, as opposedto proportional control of the motor across the entire width of thecontinuum. As mentioned above, the device 200 is an example of a devicethat can be operated over the continuum, such as the sensor 220 beingconfigured to provide a signal to the controller that the controller canuse to control the motor 206 according to the continuum of FIG. 11.

The continuum can include a “Dead Band” zone (not shown) at a leftmostend thereof, e.g., to the left of the “Reverse” zone. The “Dead Band”zone can correspond to a low level of input force. The “Dead Band” zonecan accommodate minor sensor drift from the initial zero value duringdevice operation.

FIGS. 12-13C illustrate embodiments of knife output response for theproportional control input represented by the continuum of FIG. 11. Asshown in FIG. 12, power provided by the motor can be controlled based ona position of the cutting element, e.g., knife, on the end effectorthrough which the cutting element is configured to translate. In otherwords, an output of the motor can be adjusted based on the position ofthe cutting element relative to the end effector. A speed of the cuttingelement can thus be controlled based on the cutting element's positionon the end effector since the motor's output can include power thatcauses the cutting element to translate along the end effector. Thespeed of the cutting element through tissue clamped by the end effectorcan thus reflect how much of the tissue has already been cut. Theposition of the cutting element that can be used in determining motorspeed, and hence in determining cutting element speed, can be alongitudinal position of the cutting element along a longitudinal lengthof the end effector that extends between a start position of the cuttingelement, e.g., a proximal-most position of the cutting element prior tothe cutting element cutting tissue clamped between the jaws, and an endposition of the cutting element, e.g., a distal-most position of thecutting element after the cutting element has cut tissue clamped betweenthe jaws.

The position of the cutting element on the end effector can bedetermined in a variety of ways. For example, the device can include afirst sensor at a handle portion thereof and a second sensor at thecutting element. The first sensor can be a reference sensor with which aposition of the second sensor can be compared, e.g., by a controller ofthe device. The location of the second sensor relative to the firstsensor can indicate the cutting element's position relative to the endeffector. In other words, a greater a distance between the first andsecond sensors, the farther the cutting element has translated distallyor forward along the end effector. For another example, the device caninclude a first, reference sensor at a stationary one of two jawsthereof and a second sensor at the cutting element.

The output of the motor can have a maximum limit. The maximum limit canbe different in the “Reverse” zone than in the “Forward” zone, which canreflect that it can be harder for the cutting element to move forwardsince it can cut tissue while moving forward. As shown in FIG. 12, amaximum Reverse limit for when the device is operating in the “Reverse”zone can correspond to 100% of a maximum cutting element force which iscontrolled by motor torque, e.g., by the motor's output. A maximumForward limit for when the device is operating in the “Forward” zone canbe less than the maximum Reverse limit. In the illustrated embodiment,the maximum Forward limit is 80% of the maximum Reverse limit, e.g., 80%of the maximum cutting element force which is controlled by motortorque. The value of the maximum Forward limit is 2.5 A in thisillustrated embodiment, but that value can vary based on one or morefactors, e.g., type of motor, size of end effector, size of cuttingelement, etc. The device can be configured to prevent the motor fromproviding an output above the maximum Forward limit when the device isoperating in the “Forward” zone, thereby helping to prevent the motorfrom stalling. In this way, if a user applies a relatively large amountof force to the firing actuator, such as if the user is particularlyforceful, if the user uses two hands instead of one hand to apply force,and/or if the user believes that the cutting element is havingdifficulty cutting through tissue, the device can help prevent the motorfrom increasing its output beyond safe operating limits of the motor.The device (e.g., the device 100 of FIG. 1, the device 200 of FIG. 4,and the device of FIG. 10) can be configured to be held in one hand andhave its closure trigger, firing actuator, and energy actuator allactuated by that same hand, which can help make the device easy to useand/or allow the user's other hand to attend to other matters duringsurgery. Thus, if two hands are used to apply force to the device, theforce may be too much for the motor, but the device can be configured toaddress such a scenario as discussed herein.

The maximum limit of the motor's output can based on the cuttingelement's position relative to the end effector. The maximum Forwardlimit can define an overall maximum for the motor's output when thecutting element is moving forward. The device can be configured to haveone or more lower maximum Forward limits that depend on the cuttingelement's position on the end effector. In this illustrated embodiment,the device is configured to include a first lower maximum Forward Limitfor when the cutting element is located between its initial, zeroposition and a first distance V, a second lower maximum Forward Limit,that is higher than the first lower maximum limit and lower than theoverall maximum Forward Limit, for when the cutting element is locatedbetween the first distance V and a second distance W, and the overallmaximum Forward limit for when the cutting element is between the seconddistance W and a maximum distance Y. The first and second distances V, Wcan vary based on any one or more factors, e.g., type of motor, size ofend effector, size of cutting element, etc. In this illustratedembodiment, the first lower maximum Forward Limit is 0.4 A, the firstdistance V is 0.05 in, the second distance is 0.1 in., and the maximumdistance Y of the cutting element from the zero position is 1.29 in.Thus, in this embodiment, 0 in. represents the cutting element's startposition, and 1.29 in. represents the cutting element's end position.Table 1 illustrates an embodiment of cutting element distances andmaximum allowable cutting element force (lbf).

TABLE 1 Cutting Element Max Allowable Cutting Stroke Distance (in)Element Force (lbf) 0 20 0.05 20 0.1 30 0.25 50 1.26 50

In response to reaching the overall maximum Forward limit, the device,e.g., the controller, can be configured to provide a stall alert to auser of the device. The user can thus be made aware that the motor isapproaching its maximum amount of force and that, in order to avoid amotor stall, the user should not apply additional input to the firingactuator and/or should reduce an amount of force being applied to thefiring actuator. The overall maximum Forward limit being less than theReverse limit, which as mentioned above can be 100% output, can allowthe overall maximum Forward limit to serve as a predetermined thresholdfor a stall condition since the overall maximum Forward limit can bebelow the 100% output level of the motor. The stall alert can have avariety of forms. For example, the stall alert can include the motorrepeatedly and sequentially increasing and decreasing in velocity. Thisrepeated back and forth can cause the device to palpably shake, therebyallowing a user holding the device to feel the shaking and hence receivethe stall alert. The repeated sequential increasing and the decreasingof the velocity can continue until the motor output falls below themaximum limit. The controller can be configured to cause this repeatedincrease/decrease in motor output. For another example, the stall alertcan include illuminating one or more lights on the device. For yetanother example, the stall alert can include sounding one or more tones,such as through a speaker in electronic communication with the device.For another example, the stall alert can include providing a textualmessage on a display screen coupled to the device.

As shown in FIG. 13A, absolute maximum speed of the cutting element,e.g., knife, can be based on the cutting element's position relative tothe end effector. In a first region A between the cutting element'sinitial, zero position and a third distance X greater than the seconddistance W, the cutting element can have a first maximum forward speedMax3. In a second region B between the third distance X and the maximumdistance Y, the cutting element can have a second maximum forward speedMax2. The first and second maximum forward speeds Max2, Max3 are alsoshown in FIGS. 11, 13B, and 13C. The cutting element having a firstmaximum speed Max3 during its initial forward translation through theend effector that is less than a subsequent maximum speed Max2 reflectsthat, as discussed above, tissue can become easier to cut afterapplication of heat thereto, e.g., after energy has been appliedthereto, so the cutting element can move faster therethrough toeffectively cut the tissue. The first maximum forward speed Max3 canhelp accommodate for a situation such as the end effector being fullystuffed with tissue and the user inputting a force for full speed of thecutting element. Preventing the cutting element from reaching the fullspeed by limiting the speed to the first maximum forward speed Max3,until region B is reached, can help prevent the cutting element (andcompression member, if the cutting element is attached thereto) fromjamming in the jaws.

FIG. 13B illustrates the maximum speed Max2 or Max3 of the cuttingelement, e.g., knife, as represented by motor counts per second versusknife load as represented by motor current. As demonstrated by FIG. 13B,if the cutting element encounters tissue during its forward translationtherethrough that increases the load on the motor beyond certainthresholds, the maximum speed (Max2/Max3) of the motor can be reduced.The load of the motor can be reduced as shown in the table of FIG. 13C.The numerical values in the table of FIG. 12C are representative of theillustrated embodiment. The numerical values can be different in otherembodiments based on one or more factors, e.g., type of motor, size ofend effector, size of cutting element, etc. FIGS. 13B and 13C illustratethat cutting element speed can be based on motor torque independent ofthe cutting element's position on the end effector. In other words, ifspeed decreases due to cutting element load, the speed will remaindecreased, at least until the cutting element load becomes less. FIGS.12 and 13C illustrate that motor torque can be based on position of thecutting element relative to the end effector. FIGS. 13A and 13Cillustrate that cutting element speed can be limited by position of thecutting element relative to the end effector.

Table 2 shows cutting element load being proportional to motor torque,e.g., to motor current using the values and limits of FIG. 13C. Asmentioned above, the device's controller can be preprogrammed with thesecutting element speed limits.

TABLE 2 Dynamic Response Variable User Input Calculated Max. SpeedCutting Element Load Target Time Max. Cutting Element (lbf) (seconds)Velocity (in/sec) 0 5 0.252 10 8 0.1575 20 12 0.105 40 12 0.105 60 120.105 90 12 0.105

FIG. 14 shows a time for the cutting element of Table 2 and FIGS. 12-13Cto traverse the jaws of the end effector versus the load of the cuttingelement, which in this embodiment includes a knife.

In some embodiments, the device, e.g., the device 100 of FIG. 1, thedevice 200 of FIG. 4, or the device 300 of FIG. 10, can include a motor,a cutting element, and a sensor configured to sense an impedance oftissue engaged by the device, e.g., tissue clamped by an end effector ofthe device. The motor's output can be based at least in part on thesensed impedance, thereby allowing speed of the cutting element throughthe clamped tissue to be based at least in part on the impedance of thetissue being cut. When energy is applied to tissue, such as during thesealing of tissue, water is driven out of the tissue as the tissue isheated or “cooked.” Less water in the tissue causes the impedance of thetissue to decrease, e.g., from an initial impedance in a range of about25 to 30Ω before application of energy to a range of about 3 to 4Ωduring energy application. Thus, a decrease in the tissue's impedancecan indicate that is having energy applied thereto. Similarly, the morethe tissue's impedance decreases, the more energy the tissue can bepresumed to have had applied thereto. When the tissue has become heatedor “cooked,” the impedance can begin to rise, e.g., to a range of about300 to 400Ω. The sensor sensing the tissue's impedance can thus providean indication as to whether or not the tissue is having energy appliedthereto and/or as to an amount of energy that has been applied to thetissue. The output of the sensor that indicates the tissue's impedancecan be used in controlling the motor's output so as to drive the cuttingelement faster or slower through the tissue based on the sensedimpedance. In general, when the sensed impedance is low, the motor'soutput can be low so as to move the cutting element at a relatively slowspeed since the impedance indicates that the tissue is not yet heated or“cooked.” When the sensed impedance increases, the motor's output can beincreased so as to speed up the cutting element's translation throughthe tissue since the higher impedance can indicate that the tissue haslost water due to energy application and has hence become tougher tocut, thereby likely benefiting from an increase in cutting elementspeed. Using impedance in controlling the motor's output, and hence incontrolling the cutting element's cutting speed, can be a controltransparent to a user of the device, thereby facilitating usability ofthe device since the user need not make any manual adjustments of thedevice while the tissue is being cut to facilitate efficient cutting ofthe tissue.

FIG. 15 illustrates an example of tissue impedance changing duringenergy application to the tissue and cutting element movement based onthe impedance. Energy can be applied to tissue having an initialimpedance Z1, e.g., in a range of about 25 to 30Ω. The energyapplication can cause the impedance to decrease down to a lowerimpedance Z2, e.g., in a range of about 3 to 4Ω. After the impedance hasbeen sensed at the lower impedance Z2 for a threshold amount of time,the lower impedance Z2 can be presumed to indicate the heating or“cooking” of the tissue such that the cutting element can be releasedfor movement through the tissue. The impedance can then increase fromthe lower impedance Z2 as the tissue is cut by the cutting element.Although not shown in FIG. 15, the impedance can increase higher thanthe initial impedance Z1, e.g., to a range of about 300 to 400Ω.

The sensor that senses the impedance can be attached to, for example,one of the jaws, e.g., on a tissue engagement surface thereof, so as tobe in direct contact with tissue clamped between the jaws. If the deviceincludes multiple sensors configured to sense impedance of tissueclamped by the end effector, each of the jaws can include one or moresensors configured to be in direct contact with tissue clamped betweenthe jaws.

Table 3 illustrates an embodiment of sensed tissue impedance and maximumcutting element speeds. In other words, in the embodiment of Table 3,when the sensed impedance is equal to or greater than zero Ω and equalto or less than 10Ω, a speed of the cutting element can be controlled tohave a maximum speed of zero in/sec, e.g., a controller can control thespeed to not exceed zero in/sec. The other sensed impedances and maximumcutting element speeds shown in Table 3 can be similarly controlled,e.g., when the sensed impedance is greater than 10Ω and equal to or lessthan 20Ω, the speed of the cutting element can be controlled to have amaximum speed of 0.1 in/sec, e.g., the controller can control the speedto not exceed 0.1 in/sec.

TABLE 3 Tissue Impedance Maximum Cutting (Z) (Ohms) Element Speed(in/sec) 0 ≦ Z ≦ 10  0 10 < Z ≦ 20  0.1 20 < Z ≦ 50  0.15 50 < Z ≦ 1000.6 100 < Z ≦ 1000 1.35

The surgical devices disclosed herein, e.g., the device 100 of FIG. 1,the device 200 of FIG. 4, and the device 300 of FIG. 10, can be used toperform a surgical procedure in which tissue is grasped and transected.The tissue can include, for example, stomach tissue, intestinal tissue,esophageal tissue, or blood vessels. The surgical procedure can be aminimally invasive procedure or an open surgical procedure. The surgicaldevices disclosed herein can be used in robotic-assisted minimallyinvasive or open surgical procedures.

For example, a minimally invasive surgical procedure can begin bypreparing the patient for surgery and making one or more appropriatelysized incisions at a desired location. In a minimally invasiveprocedure, one or more cannulas or trocars can be positioned in theincision(s) to provide access to the surgical site. One or more viewingdevices, e.g., scopes, can be placed in one of the incisions to allowmedical personnel to view the surgical site from outside the body. Oncethe patient is prepared for surgery, a surgical device can be insertedthrough an incision and/or through a cannula, and an end effector of thesurgical device can be positioned adjacent to a desired tissue to betreated. As the surgical device is being inserted into the patient, aclosure grip of the surgical device can be disposed adjacent to astationary handle of the surgical device so that the end effector is ina closed position and occupies a smaller amount of space than when in anopen position. When the end effector is positioned adjacent to thetissue to be treated, the closure grip can be moved away from thestationary grip, and the tissue to be treated can be positioned betweenfacing engagement surfaces of the end effector's jaws. Movement of theclosure grip toward the stationary handle can close the jaws so that theengagement surfaces are in direct contact with the tissue and so thatthe tissue is securely grasped between the jaws. A position of the jawscan directly correspond to a position of the closure grip relative tothe stationary grip. With the jaws having tissue grasped therebetween, auser can engage a firing actuator which can advance a cutting element tocut the grasped tissue and/or a compression member to further compressthe grasped tissue. In another embodiment, the device can automaticallycause a cutting element and/or a compression member to advance throughthe jaws. A person skilled in the art will appreciate that, optionally,energy can be applied to the tissue prior to or during transection ofthe tissue between the jaws, such as by actuating an energy actuator.After the cutting element is advanced through the tissue and isrefracted proximally, the device can continue to apply energy to the cuttissue or the jaws can automatically release the tissue.

FIGS. 16A-16D illustrate an embodiment of a method of using a surgicaldevice to cut and seal tissue in a surgical procedure. The method isdescribed with respect to the device 200 of FIG. 4, but any of thedevices disclosed herein, e.g., the device 100 of FIG. 1 and the device300 of FIG. 10, can be used in the method of FIGS. 16A-16D discussedfurther below. FIGS. 16A-16D show aspects of the method performed by auser (left column), by a device (middle column), and by a controller ofthe device (right column). Actions shown in FIGS. 16A-16D in rectanglesare actions performed by the user, device, or controller, while actionsshown in triangles are decisions that can determine subsequent actionsperformed, as discussed further below.

The user can attach 400 the device 200 to a power source using the powerconnector 212. For example, the power connector 212 can be plugged intoa generator. The generator can be configured to recognize the device 200as an acceptable input thereto and transmit a signal to the device 200indicating that the device 200 has been properly connected to andrecognized by the generator. The device's controller can receive 402 thesignal indicating the recognition. The device 200 being recognized bythe generator can trigger initial homing and calibration of the sensor220, e.g., sensing an initial home position of the cutting element, etc.

The user can insert the end effector 204 into a patient, e.g., through atrocar, through an incision made in the patients, etc., and position 404the device's jaws 202 a, 202 b adjacent a targeted tissue, e.g., overthe targeted tissue. The end effector 204 can be inserted into thepatient in the closed position, which can facilitate advancement of theend effector 204 into the patient through a relatively small opening.When positioned in the patient's body, the end effector 204 can beopened so as to allow the jaws 202 a, 202 b to be positioned on eitherside of the targeted tissue. The user can actuate 406 the closuretrigger 208 by pulling the closure trigger 208 toward the stationaryhandle 224. The actuation 406 of the closure trigger 208 can cause thejaws 202 a, 202 b to close and clamp the targeted tissue therebetween.

As mentioned above, the device 200 can be configured to lock the closuretrigger 208 in a fixed position relative to the stationary handle 224and/or sense when the closure trigger 208 is in close proximity of thestationary handle 224. If the closure trigger 208 is unlocked and/or thesensor 220 senses that the closure trigger is open 408, the device 200can disable 410 the motor 206 such that the motor 206 cannot be turnedon to advance the cutting element and/or the compression member (e.g.,an I-blade), if the motor 206 is not already so disabled. Also, afeathering algorithm 412 can be loaded, which can facilitate applicationof energy when the energy actuator 214 is actuated 424, as discussedfurther below. If the closure trigger 208 is locked and/or the sensor220 senses that the closure trigger is closed 408, the device 200 canenable 414 the motor 206 such that the motor 206 can be turned on toadvance the cutting element and/or the compression member (e.g., anI-blade), if the motor 206 is not already so enabled. The closuretrigger being locked and/or closed can cause the controller to set 409 alatch flag indicating that the closure trigger 208 is closed and/orlocked, and can cause the controller to load 411 a seal-only algorithm,e.g., retrieve the algorithm from a memory on board the device 200 orfrom an off-board memory in electronic communication with the device200. The algorithm can allow the controller to apply 428 energy to thetissue, as discussed further below.

After the actuation 406 of the closure trigger 208 to close the jaws 202a, 202 b, a sealing mode of the device 200 can be determined 416 tofacilitate treatment of the clamped tissue. Sealing modes includegrasping tissue, feathering tissue, touching up tissue, only sealingtissue, separately sealing and cutting tissue, and simultaneouslysealing and cutting tissue. If the clamped tissue is not to be sealed,e.g., the mode includes grasping tissue, feathering tissue, or touchingup tissue, then the user can perform any further desired tissuemanipulation. The user can then release 418 the closure trigger 208 soas to open the jaws 202 a, 202 b. The jaws 202 a, 202 b can then beremoved 420 from the targeted tissue. If the controller is configured toset a latch flag when the closure trigger 208 is closed, e.g., becausethe sensor 200 is configured to sense latch closure, then the latch flagcan be cleared 421.

If the clamped tissue is to be sealed, the tissue can be separately cutand sealed or simultaneously cut and sealed. As mentioned above, theuser can make this decision 422 based on any one or more factors, suchas personal preference, type of surgical procedure being performed, typeof the targeted tissue, etc. The user can indicate that the clampedtissue is to be separately sealed and cut by actuating 424 the energyactuator 214. When properly actuated 426, e.g., fully pressed down, thedevice 200 can apply 428 energy to the clamped tissue. The controllercan cause 430 a first energy alert to be provided to the user indicatingthat energy is being applied to the tissue, since the user may not beable to visually, audibly, and/or tactilely verify that the energy isbeing applied. The first energy alert can be provided in a variety ofways, such as by emitting a sound, illuminating a light, etc.

The sensor 220 can be configured to measure 432 impedance of the tissuewhile the energy is being applied to the tissue. The impedance can becontinuously monitored 432 during the application of the energy.Continuous monitoring of the impedance may not be precisely continuous,as will be appreciated by a person skilled in the art, due to, e.g.,limitations in speed of digital processing. In other embodiments, theimpedance can be measured at predetermined time intervals without beingcontinuous monitoring. Measuring the impedance of the tissue duringenergy application thereto, either continuously or periodically, canallow the impedance to help determine a length of time to apply theenergy to the tissue. If energy is being applied 438 to the tissue, andthe closure trigger 208 is properly closed 440, and an absolute value ofthe impedance is determined 442 by the controller, e.g., as indicted bya signal from the sensor 200, to reach a predetermined threshold value,then the controller can cause 444 a second energy alert to be providedto the user indicating that energy application to the tissue is ceasing446, since the user may not be able to visually, audibly, and/ortactilely verify that the energy is being applied. The second energyalert can be provided in a variety of ways, such as by emitting a sound,illuminating a light, etc. The second energy alert can be different thanthe first energy alert, e.g., be a different audible tone, be adifferently colored illuminated light, etc., which can help the userknow the condition being indicated by the alert. The impedance reachingthe predetermined threshold value can, as discussed above, indicate thatthe tissue has been heated and “cooked” so as to be ready for cutting.After the energy stops 446, the device 200 can reset 448 so as to beready for an optional subsequent actuation of the energy actuator 214.

Before the energy deactivates 446 automatically in response to theimpedance limit being met, the user can stop 434 actuating the energyactuator 214, e.g., stop pressing the button, such that the energyactuator 214 ceases 436 being actuated. This allows more user control oftissue sealing, as experienced users can have a sense of and/or personalpreference for how long energy should be applied to tissue.

If the user stops 434 actuating the energy actuator or if the tissue isnot being separately sealed and cut, the tissue may be subject 450 tobeing simultaneously sealed and cut. If the clamped tissue is not to besimultaneously sealed and cut, then the user can perform any furtherdesired tissue manipulation. The user can then release 418 the closuretrigger 208 so as to open the jaws 202 a, 202 b, and the jaws 202 a, 202b can be removed 420 from the targeted tissue.

If the clamped tissue is to be simultaneously sealed and cut, the usercan actuate 452 the closure trigger 408 to close the end effector 404,if not already closed, and lock the closure trigger 408 in place if thedevice 200 is configured to so lock the closure trigger 408. The usercan then actuate 454 the firing trigger 210 so as to cause the cuttingelement to translate along the end effector 204 and cut the clampedtissue. The actuation 454 of the firing trigger can also cause energy tobe applied to the clamped tissue such that the tissue is beingsimultaneously sealed and cut. While the firing actuator 210 is beingactuated 454, the device 200 can be configured to control speed of thecutting element's translation along the end effector 204 so as tocontrol a speed of the tissue's cutting. As discussed above, the device200 can be configured to control the cutting element's speed based atleast in part on an amount of user input to the firing actuator 210.

With reference to the continuum embodiment of FIG. 11, if the amount ofinput is determined 456 to be in the “Reverse” zone, then the controllercan cause the motor 206 to provide power that retracts 458 the cuttingelement to its initial home position, e.g., moves the cutting elementproximally along the end effector 204 to the start position. In thisway, whenever the cutting element can be returned to its start positionwhenever the end effector is opened, e.g., when the closure trigger 208is opened. This can help prevent the cutting element from being exposedand accidentally cutting tissue and/or other matter near the endeffector, which is not closed when the closure trigger is not closed.The sensor 220 can be configured to monitor 460 a position of thecutting element relative to the end effector 204. The controller can beconfigured to receive an output from the sensor 220 indicating theposition, which the controller can use in controlling the motor's outputto reverse 462 the cutting element. If the amount of input is determined464 to be in the “Hold” zone, then the controller can cause the motor206 to not 466 provide power to the cutting element such that thecutting element does not move relative to the end effector 204. Beingdetermined 464 to be in the “Hold” zone can cause the controller to load492 a simultaneous seal and cut algorithm, e.g., retrieve the algorithmfrom a memory on board the device 200 or from an off-board memory inelectronic communication with the device 200. The algorithm can allowthe controller to apply 494 energy to the tissue before the cuttingelement begins to cut the tissue, e.g., before the amount of inputenters the “Forward” zone. This heating or “cooking” of the tissuebefore the tissue begins to be cut can make the tissue easier to cut,which can allow the motor to provide less power than it would need toprovide if the tissue were not pre-heated by the energy application,and/or can help subject a compression member attached to the cuttingelement to lower forces, which can help prevent damage thereto. Themotor can thus perform more efficiently and/or can be a smaller motorthan needed without the pre-heating. Similar to that discussed above,the controller can cause 496 the first energy alert to be provided tothe user indicating that energy is being applied to the tissue, andimpedance can be measured 498 while the energy is being applied to thetissue. If the user input is determined 500 to move from the “Hold” zoneto the “Reverse” zone, then energy application can cease 482, asdiscussed further below. If the user input is not determined 500 to movefrom the “Hold” zone to the “Reverse” zone, then the user input ispresumed to be in the “Hold” zone or the “Forward” zone, so energyapplication can continue until it is determined 502 that the cuttingelement has been fully deployed, e.g., reached its end position. Energycan thus be applied in the “Hold” and “Forward” zones but not in the“Reverse zone.” The controller can then determine 478 whether or not thetissue has reached its predetermined threshold value of impedance, e.g.,a target impedance, as discussed further below.

If the amount of input is determined 464 to not be in the “Hold” zonebut is determined 468 to be in the “Forward” zone, then the controllercan cause the motor 206 to provide power that advances 470 the cuttingelement from its initial home position, e.g., moves the cutting elementdistally along the end effector 204. The sensor 220 can be configured tomonitor 472 the position of the cutting element relative to the endeffector 204. The controller can be configured to receive an output fromthe sensor 220 indicating the position, which the controller can use incontrolling the motor's output to advance 474 the cutting element and incontrolling the motor's output to stop 476 the forward advancement ofthe cutting element when the cutting element reaches its end position.

When the forward advancement 474 of the cutting element stops 476, thecontroller can determine 478 whether or not the tissue has reached itspredetermined threshold value of impedance, e.g., a target impedance. Ifthe tissue has not reached the predetermined threshold value ofimpedance, that can indicate that the tissue has not been adequatelysealed. The device 200 can thus apply 428 energy to the clamped tissue.If energy is already being applied to the tissue, energy can continuebeing applied. If energy is not already being applied, then energyapplication can begin. If the tissue has reached the predeterminedthreshold value of impedance, then the controller can cause 480 a thirdenergy alert to be provided to the user indicating that cutting of andenergy application to the tissue is ceasing 446, since the user may notbe able to visually, audibly, and/or tactilely verify that the energy isbeing applied or that cutting is occurring. The controller can stop 482energy application since the tissue has been determined to have been cutand sealed. The device 200 can reset 484 so as to be ready for a nextcycle of energy application, such as when a second tissue is clampedbetween the jaws.

After actuating 454 the firing trigger 210 so as to cause the cuttingelement to translate along the end effector 204 and cut the clampedtissue, as discussed above, the user can release 486 the firing trigger210. The release 486 of the firing trigger 210 can cause, with referenceto the continuum embodiment of FIG. 11, the user input to the firingtrigger 210 to move from the “Forward” zone to the “Hold” zone, and fromthe “Hold” zone to the “Reverse” zone. Entering 488 the “Reverse” zonecan cause 490 the cutting element to be retracted, e.g., by thecontroller causing the motor to reverse direction so as to reversemovement of the cutting element from a distal cutting direction to aproximal retraction direction. The cutting element being refracted toits start position can trigger the device 200 to reset 484 so as to beready for a next cycle of energy application.

A person skilled in the art will appreciate that the present inventionhas application in conventional minimally-invasive and open surgicalinstrumentation as well application in robotic-assisted surgery.

The devices disclosed herein can also be designed to be disposed ofafter a single use, or they can be designed to be used multiple times.In either case, however, the device can be reconditioned for reuse afterat least one use. Reconditioning can include any combination of thesteps of disassembly of the device, followed by cleaning or replacementof particular pieces and subsequent reassembly. In particular, thedevice can be disassembled, and any number of the particular pieces orparts of the device can be selectively replaced or removed in anycombination. Upon cleaning and/or replacement of particular parts, thedevice can be reassembled for subsequent use either at a reconditioningfacility, or by a surgical team immediately prior to a surgicalprocedure. Those skilled in the art will appreciate that reconditioningof a device can utilize a variety of techniques for disassembly,cleaning/replacement, and reassembly. Use of such techniques, and theresulting reconditioned device, are all within the scope of the presentapplication.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A surgical device, comprising: a proximalportion; an elongate shaft extending distally from the proximal portion;an end effector at a distal end of the elongate shaft, the end effectorincluding first and second jaws configured to grasp tissue betweenfacing engagement surfaces thereof, the end effector being configured tomove between a closed position, in which a minimum gap exists betweenthe facing engagement surfaces when no tissue is being grasped by theend effector, and an open position in which another, larger gap existsbetween the facing engagement surfaces; a first conductive memberconfigured to directly engage the grasped tissue and apply energy to thegrasped tissue; and a second conductive member configured to directlyengage the grasped tissue when the first conductive member applies theenergy thereto, the second conductive member being configured tomaintain the minimum gap when the first and second jaws are in theclosed position.
 2. The device of claim 1, wherein, when the minimum gapexists between the facing engagement surfaces, the second conductivemember is configured to directly engage the facing engagement surface ofthe first jaw without directly engaging the facing engagement surface ofthe second jaw.
 3. The device of claim 1, wherein the first jaw ismovable relative to the elongate shaft, to the second jaw, and to thefirst and second conductive members so as to move the end effectorbetween the open and closed positions.
 4. The device of claim 1, whereinthe first and second jaws are each movable relative to the elongateshaft so as to move the end effector between the open and closedpositions.
 5. The device of claim 1, wherein the first and secondconductive members are each part of the same one of the first and secondjaws.
 6. The device of claim 1, further comprising a third conductivemember configured to directly engage the grasped tissue and apply energyto the grasped tissue, the first conductive member being on the facingengagement surface of the first jaw and the third conductive memberbeing on the facing engagement surface of the second jaw.
 7. The deviceof claim 6, wherein the second conductive member is attached to thefirst jaw and extends from the facing engagement surface of the firstjaw in a direction toward the facing engagement surface of the secondjaw.
 8. A surgical device, comprising: a proximal handle portion; anelongate shaft extending distally from the proximal handle portion; afirst jaw at a distal end of the elongate shaft, the first jaw having afirst tissue engagement surface; a second jaw at the distal end of theelongate shaft, the second jaw having a second tissue engagementsurface, at least one of the first and second jaws being movablerelative to the elongate shaft to facilitate clamping of tissue betweenthe first and second tissue engagement surfaces; a first conductivemember forming at least a portion of the first tissue engagementsurface, the first conductive member being configured to apply energy tothe tissue clamped between the first and second tissue engagementsurfaces; and a second conductive member extending from the first tissueengagement surface in a direction toward the second tissue engagementsurface, the second conductive member being configured to contact thefirst tissue engagement surface so as to maintain a minimum amount ofspace between the first and second tissue engagement surfaces, and thesecond conductive member being configured to not conduct energy when thefirst conductive member is applying the energy.
 9. The device of claim8, wherein the first tissue engagement surface has a plurality of holesformed therein and the second conductive member includes a plurality ofconductive members, each of the plurality of holes having one of theplurality of conductive members extending therethrough.
 10. The deviceof claim 8, wherein the first and second conductive members are not indirect contact with one another.
 11. The device of claim 8, furthercomprising a third conductive member forming at least a portion of thesecond tissue engagement surface, the third conductive member beingconfigured to apply energy to the tissue clamped between the first andsecond tissue engagement surfaces.
 12. The device of claim 11, whereinthe second conductive member is configured to contact the thirdconductive member so as to maintain the minimum amount of space betweenthe first and second tissue engagement surfaces.
 13. The device of claim8, further comprising a cutting element configured to translate alongthe first and second jaws so as to cut the tissue clamped between thefirst and second tissue engagement surfaces.
 14. The device of claim 13,wherein the cutting element is formed of a conductive material.
 15. Thedevice of claim 8, wherein the second conductive member includes aplurality of posts.
 16. The device of claim 8, wherein material formingthe second conductive member is unitary with material forming the firstjaw.
 17. A surgical device, comprising: first and second jaws configuredto grasp tissue therebetween, the first and second jaws being configuredto move between a fully closed position when no tissue is being graspedby the first and second jaws, in which facing tissue engagement surfacesof the first and second jaws are not in direct contact and in which afirst non-zero distance exists between the facing engagement surfaces,and an open position when no tissue is being grasped by the first andsecond jaws, in which a second non-zero distance exists between thefacing engagement surfaces, the second non-zero distance being greaterthan the first non-zero distance; one or more electrodes configured toapply energy to the grasped tissue; and one or more conductive spacersconfigured to maintain the first non-zero distance between the first andsecond jaws when the first and second jaws are in the fully closedposition.
 18. The device of claim 17, wherein the one or more conductivespacers are configured to directly contact the grasped tissue when theenergy is applied thereto.
 19. The device of claim 17, wherein the oneor more conductive spacers are each spaced a distance apart from the oneor more electrodes.
 20. The device of claim 17, further comprising aproximal handle portion; and an elongate shaft extending distally fromthe proximal handle portion, the first and second jaws being attached toa distal end of the elongate shaft.